
Class JSMi^L 
Book , -_ 



Copyright N°_ 



COFWtlGHT DEPOSIT. 



THE CLIMATIC TREATMENT 
OF CHILDREN 



THE 

CLIMATIC TREATMENT 

OF CHILDREN 



BY 
FREDERICK L. WACHENHEIM, M.D. 

Chief of Clinic, Children's Department, Mount Sinai - 
Hospital Dispensary, New York 




NEW YORK 

REBMAN COMPANY 

1123 BROADWAY 



LIBRARY of CONGRESS 
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Copyright, 1907, 

By REBMAN COMPANY 

New York 



PREFACE 

The present work is intended to fill a vacant place in 
medical literature. While a good deal has been written 
on the climatic treatment of adults, most of it is some- 
what one-sided, referring too exclusively to the manage- 
ment of tuberculosis. The climatotherapy of early life 
has been rather neglected; it differs widely, often radi- 
cally, from that of older persons, but we have nothing 
important or comprehensive in the English language, or 
bearing on American practice, concerning this division 
of the subject. 

Treatises on medical climatology are apt to deal too 
largely in generalities, whereas the practitioner is called 
upon to prescribe a change of air with some precision. 
I have therefore, in the description of climates, gone 
into very minute detail, especially in regard to this 
continent. The chapter on the climatology of temperate 
North America is the first attempt to present, in accessi- 
ble form, a large mass of material hitherto lying buried 
in government reports. Somewhat fewer details are 
given in regard to foreign climates, on which good 
monographs have been published in England; they are, 
nevertheless, not neglected on the following pages. 

No work on climatotherapy can be really satisfactory, 
unless it partakes of the features of a ready reference 
manual. For this reason, I have appended a very 
complete index, extending to individual localities, so 



VI PREFACE 

that the reader may inform himself as to climatic 
minutiae with the smallest possible loss of time. A 
manual of this sort will be a useful supplement to the 
ordinary treatise on therapeutics, which rarely embraces 
more than generalized climatic recommendations. 

Finally, the urgent need, in this country, of better 
provision for the children of the poorer classes will be 
touched upon. This point of view has been forced upon 
me in the course of preparing this volume; America has 
lagged very far behind Europe in this regard, and even 
now our awakening is but slow and unsatisfactory. 
Possibly this book may act as a stimulus in this very 
important direction; the feasibility of adequate climatic 
treatment of children rests largely on economic factors, 
to the bearings of which communal workers, as well as 
physicians, should rouse themselves with more energy 
than they have so far displayed. 

The Author. 



CONTENTS 

CHAPTER I 

GENERAL PRINCIPLES 

Physiology of climate, temperature, humidity, variability of tem- 
perature, sensible temperature, cloudiness, rain, snow, fog, winds, 
atmospheric pressure, physiology of high elevations, mountain 
sickness, phototherapy at high elevations, temperature at eleva- 
tions, the seashore, classification of climates, general application, 
application to childhood, climate and disease, insect-borne 
diseases, hay-fever Pages 1-49 

CHAPTER II 

THE CLIMATOLOGY OF TEMPERATE NORTH AMERICA 

Topography, atmospheric pressure and prevailing winds, tempera- 
ture, cloudiness and humidity, precipitation Pages 50-138 

CHAPTER III 

HEALTH RESORTS 

North American resorts; foreign resorts: western Europe, central 
Europe, the Mediterranean region; sea voyages, sea bathing, 

Pages 1-39-206 

CHAPTER IV 

THE CLIMATIC MANAGEMENT OF THE NORMAL CHILD 

General considerations, warming and ventilation, housing, cloth- 
ing, " catching cold," hardening, summer resorts, seashore 
resorts, inland resorts, elevations, winter resorts, spring resorts, 

autumn resorts." Pages 207-249 

vii 



Vlll CONTENTS 

CHAPTER V 

CONSTITUTIONAL DISEASES 

The errors of nutrition and development : simple malnutrition, 
rickets, anaemia.- Systemic diseases: rheumatism and the 
rheumatoid diseases, the hemorrhagic diseases, amyloidosis, 
congenital syphilis, malaria Pages 250-286 

CHAPTER VI 

VISCERAL DISEASES . 

Diseases of the uropoietic system: albuminuria, nephritis, the 
"surgical" kidney, diseases of the bladder. Diseases of the 
digestive system, acute diarrhceal diseases, chronic diarrhceal 
diseases, non-diarrhceal dyspepsia. Respiratory diseases : chronic 
bronchitis, chronic inflammation of the upper air passages, 
pneumonia and pleurisy, pertussis, hay-fever. Diseases of the 
- ear. Diseases of the heart: compensated valvular lesions, 
cardiac insufficiency, congenital heart disease, pericarditis. 
Diseases of the nervous system : nervous irritability and nervous 
exhaustion, enervation, insomnia, the spasmodic affections, 
the paralytic affections, the painful neuroses. Diseases of the 
skin j ' Pages 287-352 

CHAPTER VII 

SCROFULOSIS AND TUBERCULOSIS 

Scrofulosis. Tuberculosis: surgical tuberculosis, visceral tuber- 
culosis. Sanatoria Pages 353-381 



(For practical reasons, it has seemed best to give temperatures 
in Fahrenheit degrees, and elevations in feet, in preference to 
employing the centigrade scale and metric system). 



THE CLIMATIC TREATMENT 
OF CHILDREN 



CHAPTER I 

GENERAL PRINCIPLES 

The practice of medicine, as distinct from surgery, 
employs two therapeutic methods which we may desig- 
nate as chemical and physical; the former consists in the 
administration of drugs and the like, the latter in the 
application of the great natural forces. The conditions 
of the atmosphere, called meteorological, supply these 
forces in an almost infinite variety of combination, and 
in a most conveniently applicable form; climatic treat- 
ment therefore constitutes probably the most generally 
useful department of physical therapeutics, and as such 
merits a more thorough and detailed study than it has 
hitherto obtained. 

We most easily appreciate the value of climatic 
therapy when we recall that our other physical meas- 
ures, namely baths, massage, electricity, and the newer 
photo- and radiotherapy, generally apply but one agent 
at a time. Climatic treatment not only comprises the 
application of heat and cold, though this forms its great- 
est and most important part; it also employs the atmos- 
pheric pressure, sunlight, a species of massage by the 
winds, and the atmospheric moisture. We therefore 

l 



2 THE CLIMATIC TREATMENT OF CHILDREN 

have no difficulty in recognizing that its action may 
often be superior to that of any one physical agent, but 
we also see that careful study and good judgment are 
requisite, if we wish to present the various climatic ele- 
ments in the combination most suitable to the particular 
individual who comes to us for relief. We must there- 
fore introduce our subject with a statement of its general 
principles and an outline of its main spheres of usefulness. 
In acute disease, we do not often resort to climatic 
treatment; here its main value is prophylactic, and in 
this direction we may often achieve admirable, though 
not always demonstrable results. This end is practically 
accomplished by choosing a healthful climate for the 
permanent residence of the normal or nearly normal 
individual. In chronic disease, on the other hand, the 
judicious selection of climate is one of our most valuable 
resources, and an efficient adjunct to medication and the 
other physical remedies. Both of these aspects of the 
subject shall receive extended discussion as we proceed. 
. Special attention attaches to the climatotherapy of 
childhood. The young subject is far more responsive 
to his physical environment than the adult; he not only 
requires the maintenance of health for the time being, 
but demands, in addition, surroundings favorable to his 
normal progressive growth and development. On ac- 
count of his relatively very active metabolism, he also 
affords better opportunities for checking the advance 
and repairing the ravages of various ailments. Thus the 
proper application of physical measures may be expected 
to yield particularly good results in infants and children, 
and among these measures the selection of a beneficial 
climate takes a high rank. 



GENERAL PRINCIPLES 3 

The cardinal principles of climatic therapeutics are 
those so aptly laid down by Hoffmann 1 for indirect 
therapeutics in general, namely training and rest, 
expressed by him somewhat better in the German terms 
Uebung and Schonung. Training (Uebung) is called for 
under such circumstances as the following. An organ, 
or the entire organism, may never have learned to per- 
form a full, normal quantum of work; it may have all 
along either managed to shirk a certain proportion of 
its duties, or shown an abnormal tendency to break 
down under a moderate strain. In such a case, it falls 
to the physician gradually to train and educate the 
inadequately developed organ or body, not to stimulate 
it, as is so often done, with strychnin and the like. It 
would be regarded as most unintelligent to force a boy 
to do a man's physical work; yet, presumably compe- 
tent practitioners are attempting a parallel to this every 
day, with their sub-normal patients as subjects, and too 
often as victims. • 

The above aptly illustrates the difficulty involved in 
raising the subnormal adult to par; training often fails 
in later life, even though it may not always entail the 
potential harm of overstimulation. In the child we are 
dealing with a somewhat different proposition; the 
growth of its body is still incomplete, its later years may 
be managed so as to yield better results, some of the lost 
ground may yet be recovered. We are therefore justified 
in dwelling at some length on the physical, particularly 
the climatic, therapeutics of the approximately normal 
child, in addition to discussing the treatment of actually 
sick children. 

1 Vorlesungen (iber allgemeine Therapie, Leipzig, 1888. 



4 THE CLIMATIC TREATMENT OF CHILDREN 

A seriously diseased organ or organism requires rest; 
not always absolute rest, which is indeed usually unob- 
tainable, but relative rest, what the Germans call 
Schonung, secured by a scaling down of the normal quota 
of work, either by enforced inactivity, or by shifting 
functions into vicarious channels. This indication is 
usually met more successfully than that of training, but 
not because of greater medical skill and resources. We 
shall have occasion to observe, as we go on, that most of 
the superiority of rest-cures, in the broad sense, over 
courses of training, so far as achieving tangible results 
is concerned, is due to a combination of circumstances. 
This peculiarity attaches to climatic treatment in an 
eminent degree, and we shall avoid unnecessary digres- 
sion by investigating it from this standpoint alone; a 
brief survey of a few climatic, anthropological and 
physiological facts will make this matter perfectly 
clear. 

The Physiology of Climate. The distinction between 
climate and weather cannot be stated better than in 
Hann's introductory words: "By climate we compre- 
hend the total of the meteorological phenomena that 
characterize the average state of the atmosphere at any 
one locality on the earth's surface. What we call 
weather is merely a phase, a single act, of the succession 
of phenomena, whose perennially more or less similar 
course constitutes the climate of a locality." Physio- 
logically, we cannot maintain this distinction, for the 
human body must provide not only for average, but also 
for occasional and even exceptional meteorological con- 
ditions. Thus, medical climatology includes both cli- 
matology and meteorology within its scope, and is not 



GENERAL PRINCIPLES 5 

an exclusive application of the former alone; it is only 
the mathematical accuracy of the former science, as 
opposed to the numerous uncertainties still obscuring 
the latter, that have given the branch of medical science 
here under discussion its present trend and consequent 
appellation. 

Few creatures are capable of so widespread an accli- 
matization as is man; yet, in spite of his range over 
almost the entire globe, he too, like all other animals, 
thrives better under some conditions than others, as is 
readily proved by a few statistical data. The average 
temperature of the earth's surface is 55 degrees, or 
thereabout; a careful survey of the various inhabited 
countries shows that the majority of the human species 
dwell in regions warmer than this, and that the countries 
averaging below 32 degrees are very sparsely settled. 
Historical research shows that, previous to the nineteenth 
century, the disproportion was several times as great as 
now; the cooler temperate zones have only begun to be 
filled up within a century or two, and it is not difficult 
to prove that the recent change is chiefly due to modern 
industrialism. None of the colder countries can feed 
their population with their own products alone, save in 
such recently opened districts as our own Northwest, 
where the density of the population as yet rarely ap- 
proaches twenty to the square mile. 

Man evidently is at least as well adapted to warm as 
to cool climates, even with his present constitution, 
which is altogether acquired; he does not do very well 
in .climates where frost is the rule. Anthropological 
studies, however, go far beyond this; the hairless skin 
of man, as well as recent investigations as to his origin, 



6 THE CLIMATIC TREATMENT OF CHILDREN 

point to the tropical regions as his aboriginal home; 
they are the sole abode of the anthropoid primates, as 
well as of nearly all the evidently primitive human 
tribes (pygmies, negritos). It would therefore appear 
that our aboriginal environment is that of a very warm 
and humid climate, and that only a minority of our 
species have become habituated to cool regions by a very 
gradual process of acclimatization, aided by the inven- 
tion of protective clothing. Now it happens that nearly 
all medical research has emanated from this minority, 
and that the human pathology best known is that of a 
cool climate; indeed, until recently, most of our ailments 
were attributed to the vicissitudes of that climate, and 
this opinion probably contains more than a grain of 
truth. It is therefore not strange that removal to a 
more genial zone should always have been regarded as a 
most valuable remedy for disease. 

We thus see why the first attempts at climatotherapy 
were based on the principle of sparing the diseased 
organism the shocks unavoidable in a harsh climate; 
until quite recently this phase alone was studied, hence 
the somewhat one-sided development of our science. 
The sparing indication is met all too easily, but the indi- 
cation for training, with the avoidance of injury, is 
satisfied with far more difficulty, and has hitherto been 
handled rather empirically. As a consequence, the re- 
sults, especially in children, have been rarely brilliant 
and often disastrous, although a rational method can 
undoubtedly be worked out with the aid of even such 
data as are already at hand; what we need most of all 
is to keep in close touch with our physiological standards, 
and to set out with a clear understanding of the effect 



GENERAL PRINCIPLES 7 

of the various climates on the normal subject. We may 
therefore begin with a brief review of the physiological 
relations of the atmospheric phenomena. 

Temperature. The nude body of a healthy adult, when 
at rest, maintains its normal warmth of 99 degrees most 
easily at an air temperature of about 80; this may be 
called the indifferent temperature, and is reduced by 
very light summer clothing to about 75, by heavy winter 
dress to about 65 degrees; under these circumstances 
we feel just comfortable, when lying down or otherwise 
inactive. At lower temperatures we are obliged to 
furnish an additional amount of body heat; this we 
accomplish by means of an accelerated oxidation of our 
tissues, in its turn requiring an increased supply of 
oxygen through augmented respiratory activity. We 
achieve this extra oxidation most readily by means of 
muscular exertion; moderate muscular exercise, such 
as walking at a steady gait, lowers the indifferent tem- 
perature about ten degrees more. We can indeed effect 
a still further reduction by violent exercise, but this is 
so rapidly limited by muscular exhaustion that it is 
available only for a brief space of time. We therefore 
require artificial heat in our rooms whenever their tem- 
perature falls much below 65 degrees; out of doors, when 
we move about freely, we can dispense with extra wraps 
and overcoats at a lower temperature, down to about 
55. Exposure to the direct rays of the sun introduces 
a factor so variable as to preclude any reduction to 
figures; it must suffice to state that a leeway of an 
indefinite, but often considerable, number of degrees is 
thereby afforded, depending chiefly upon the clearness 
of the sky. Under favorable conditions a sunny and 



8 THE CLIMATIC TREATMENT OF CHILDREN 

sheltered spot will feel comfortably warm at shade tem- 
peratures near the freezing-point. 

In water, an excellent conductor of heat compared 
to the air, the indifferent temperature is very much 
higher, 90 to 92 degrees in adults, 95 in- young children, 
and 98 in early infancy. These data are entered here, 
in order to dispose of this subject at once; besides, as 
we shall see, bathing is often made to form part of a 
course of climatic treatment. 

The resting or sparing indication is therefore fulfilled 
adequately in a climate affording a daylight temperature 
of between 65 and 75 degrees, corresponding to an aver- 
age temperature considerably lower, for the night tem- 
peratures concern us relatively little so long as they are 
not uncomfortably high and interfere with sleep. A 
lower day temperature is restful only if exercise can be 
indulged in, therefore neither in extreme invalidism nor 
when walking is impossible for other reasons. At day 
temperatures below 55 degrees, the element of training 
supplants that of rest, and whenever the latter alone is 
desired, so cool a climate is contraindicated. We can 
easily see that, near this thermal border line, it is possible 
to introduce some very delicate gradations with regard 
to the relative adjustment of temperature, rest, and exer- 
cise. On the one hand, the efficiency of the locomotor 
apparatus may be the chief consideration; on the other, 
the adequacy of the respiratory, circulatory, and excre- 
tory organs may weigh more heavily. ■ We also see 
how precise but delicate a therapeutic measure climatic 
treatment becomes so soon as we have to employ it in 
meeting the indication of training, and how simple its 
application is when rest is the sole desideratum. 



GENERAL PRINCIPLES 9 

The generally superior efficacy of rest-cures, in actual 
practice, is readily understood from the above discussion; 
it is almost entirely due to the ease 'and certainty of 
their application. It is also clear, however, that we can 
do excellent work, with skillful management, in cases 
where training is the object in view. The whole secret 
lies in the careful adjustment to the patient of tempera- 
tures below the indifferent point, and we shall have 
ample occasion to return to this subject when, in the 
following chapters on applied climatotherapy, we refer, 
again and again, to the therapeutic procedure commonly 
called " hardening," the most important and most abused 
of climatic measures. 

When the temperature of the air exceeds 75 degrees, 
the body, even though at rest and lightly clothed, pro- 
duces more heat than is needed for the maintenance of 
its normal warmth. The disposal of its surplus heat is 
effected, in the first instance, by radiation, which is, 
however, at best, limited to a moderate amount and 
greatly interfered with by even a minimum of clothing. 
The final resort of the human organism to meet the 
stated condition is the production and evaporation of 
sweat, which is very effective under favorable circum- 
stances. The mere production of sweat, however, calls 
for additional work on the part of the vasomotor appa- 
ratus, and especially an accelerated action of the heart; 
heat is therefore altogether a stimulant, a point fre- 
quently disregarded in therapeutics. Many practitioners 
consider very warm climates as generally sedative, but 
the confusion with the merely mild climates is obvious, 
the distinction involves more than a fit tie difference. In 
the present discussion we have set the border line at 



10 THE CLIMATIC TREATMENT OF CHILDREN 

about 75 degrees; even this is, as we have seen, some- 
what too high to be truly sedative whenever any amount 
of physical exertion is desirable; in subjects calling for 
the last, a lower level of temperature is quite essential 
to meet the indication of rest. 

Humidity. The matter does not rest with the mere 
secretion of sweat; its rapid and complete evaporation 
from the surface of the body is really the chief point. 
In this connection an entirely new factor comes into 
play, namely, the relative humidity of the surrounding 
air. Approximate saturation of the atmosphere with 
aqueous vapor totally bars evaporation, which becomes 
more and more effective as the proportion of moisture, 
the relative humidity of the air, falls below the point of 
saturation, 100 per cent. 

Inasmuch as the atmospheric humidity affects us 
chiefly as regards the evaporation of cutaneous moisture, 
it is evident that our perception of this meteorological 
factor is indistinct at low temperatures, becoming well 
defined only above the indifferent point, about 55 degrees; 
below this, our impressions of the atmospheric humidity 
are quite apt to be fallacious. We are often told, for 
example, that the winter' weather in New York City is 
damp during the cold spells; as a matter of fact, the 
relative humidity ranges from 60 down to 40 per cent, 
and less on these occasions. We are also informed that 
the intense cold. in the Adirondack Mountains is "dry." 
The truth is that the mean relative humidity is lower in 
winter in the seaboard region about New York Gity than 
anywhere else in the state, and it is likewise true that 
the traditional "dry cold" of Minnesota and Iowa is also 
five per cent, moister than that of the Middle Atlantic 



GENERAL PRINCIPLES 11 

coast. So much for popular impressions on this subject; 
the fact remains that the proportion of moisture at low 
temperatures is practically imperceptible and immaterial, 
as the transpiration through the skin is, in any case, 
insignificant in cold weather compared to its vast 
importance in summer. 

From 55 degrees upward, on the other hand, the 
effects Of moist, as contrasted with dry air, become 
increasingly perceptible, growing dominant when the 
atmospheric temperature rises into the seventies. At 
very high temperatures, indeed, dryness becomes abso- 
lutely essential to the mere maintenance of life. A 
temperature near that of the body, with the air almost 
saturated with moisture, will, in a very short time, cause 
fatal hyperpyrexia, so-called " heat-stroke," or "sun- 
stroke," as the result of the accumulation of body heat 
which is continually produced without the possibility of 
elimination. The frequent fatalities due to the com- 
bination of high temperature and humidity are suffi- 
ciently familiar; the danger line lies very near the point 
indicated' by the preceding discussion; namely, at 75 
degrees with 100 per cent, of moisture, equivalent to 80 
degrees with 80 per cent., 90 degrees with 50 per cent., 
and 100 degrees with 30 per cent. ; all these combinations 
are quite frequent in many parts of our continent, during 
the warmer months. We see, furthermore, that very 
intense heat may be endurable and quite safe, provided 
the air be dry; in our semi-arid districts, a temperature 
of 100 degrees is often associated with only 10 per cent, 
of humidity; this is equivalent to saturated air at -only 
70 degrees, and therefore relatively harmless if violent 
exertion and exposure to the far hotter direct rays of 



12 THE CLIMATIC TREATMENT OF CHILDREN 

the sun be avoided. Heat-stroke is infinitely commoner 
in our humid East than in the far drier though often 
hotter West. 

The sensation produced by the approach to the danger 
line is called sultriness; since the normal person leads a 
more or' less active life, this unpleasant, condition be- 
comes perceptible in a saturated atmosphere no warmer 
than 65 degrees. This is the average temperature of 
the wet-bulb thermometer at New York in mid-June and 
early September, and between those dates this climate is 
notoriously sultry and unwholesome. It is interesting to 
note the agreement on this subject between the popular 
impression and the scientific data. 

The last paragraphs abundantly illustrate the fallacy 
involved in the common belief that the very warm 
climates are restful. The unremitting stimulation of 
the vasomotor apparatus, that attends even a short 
residence in such a region, has by no means a hardening 
effect ; on the contrary, the main result achieved is 
vasomotor exhaustion/ a part of the general systemic 
condition called enervation, the patient returning home 
enfeebled and less resistant than before. This is shown 
most conspicuously in an extreme sensitiveness to mod- 
erate changes of temperature; a fall of ten o fifteen 
degrees, which we should barely notice, may entail seri- 
ous consequences in an enervated subject. The same 
thing is observable in our northern summer: the pro- 
verbially severe and persistent "summer cold" is 
especially prevalent after a long hot spell, and fol- 
lows a decline in the temperature that would almost 
escape attention in the cold season. This invariably 
acquired thermic hyperesthesia is alone a sufficient 



GENERAL PRINCIPLES 13 

reason for laying down the general rule that the hot 
climates and seasons be excluded absolutely from our 
therapeutic armamentarium. Their harmfulness is, 
indeed, being more and more widely recognized, so 
that the old practice of sending invalids to such 
regions as the West Indies is rapidly falling into com- 
plete desuetude. 

The Variability of Temperature. We usually measure 
the variability of the temperature by the amount of rise 
or fall from day to day, employing as guides either the 
daily means or the temperatures at a fixed hour. It is 
also of advantage to note the excessively rapid changes 
that occur more or less frequently in the more variable 
climates, such as that of the eastern United States. 
From the purely mathematical point of view, the method 
just stated is unquestionably correct; applied to the 
human organism, it gives a distinctly false impression. 
It is certainly not true that we feel a fall from 30 degrees 
to zero as much as one from 60 to 30, the reason being 
that we instinctively refer all our thermic sensations to 
the indifferent point, regardless of the actual graduation 
of the thermometer ; as the temperature departs farther 
from the indifferent point, our perception becomes pro-_ 
gressively less keen. A drop from 80 to 50 degrees, as 
sometimes occurs in spring, is felt most acutely, for the 
change is from above the indifferent temperature to 
below it. A similar fall from 50 to 20 degrees is far less 
trying, and one from 20 to —10 incommodes us only 
moderately; temperatures below zero all feel very 
much alike, so that travelers may honestly report that 
— 30 degrees in Canada seem no colder than zero in 
Pennsylvania. 



14 THE CLIMATIC TREATMENT OF CHILDREN 

The above sketch accounts for the popular impression 
of the changeableness of the temperature in spring; 
purely mathematical data show plainly that the winter 
months are very much more variable ; they do not, how- 
ever, appear so to the human organism. We here have 
one of the many instances in which purely theoretical 
considerations on climatic questions are altogether 
misleading. 

A sudden rise of temperature affects us far less than an 
equal fall. The former almost always takes place during 
the daytime, when a certain elevation is expected in any 
case; the latter is relatively harmless when it occurs 
during the night, but more serious during the day, when 
we are apt to be out of doors, and prepared for a rise of 
temperature instead of a fall. Furthermore, we must 
again recall that man, being essentially a tropical ani- 
mal, can withstand a rapid warming better than a sudden 
chill. 

Sensible Temperature. It was Harrington l who first 
popularized the idea of " sensible temperature," re- 
garding as such the temperature indicated by the wet- 
bulb thermometer, to which the surface of the body is 
far more akin than to the ordinary dry thermometer. 
His method is not quite accurate, as he does not allow 
for the cooling effect of air currents, but the wet bulb 
alone far more closely represents the modification of 
temperature by humidity as felt by the moist human 
skin than any other simple means; we may therefore 
avail ourselves of his idea with profit. The following 
table gives a few sensible temperatures, by way of illus- 
tration, and for reference; low temperatures being 

1 International Med. Magazine, August 1894. 






GENERAL PRINCIPLES 



15 



omitted as unimportant for our purpose, and to save 
space: 



Dry 

Thermometer 


Humidity 


90% 


80% 


70% 


60% 


50% 


40% 


30% 


20% 


10% 


no 


107 
97 

88 
78 
68 
58 


104 
94 

85 
75 
66 
56 


100 
91 
82 
73 
64 
54 


96 
87 
79 
70 
61 
52 


92 
83 
75 
67 
59 
50 


87 
79 
71 
64 
56 
48 


82 
74 
67 
60 
53 
46 


76 
69 
63 
57 
50 
44 


70 


100 


63 


90 


58 


80 


53 


70 


47 


60 


42 







We see that 110 degrees in Arizona, with the humidity 
at 20 per cent., feel about the same as 90 degrees in New 
York, with 50 per cent, of moisture, but we must not 
carry this line of argument too far. Exposure to the 
sun is a very different thing in the former place from 
such in the latter; furthermore, the breezes at these 
respective temperatures feel altogether different, one 
being far above the body temperature, the other 
well below it. As stated above, Harrington's method 
tells only part of the story; the Arizona summer is 
warmer than that of New York, and the dryness of 
the air only partly mitigates its fervor. 

Vincent 1 attacked this problem from another view- 
point. He determined the coefficient of reduction for 
the surface warmth of the body, at temperatures below 
the blood heat, and found that it amounted to 0.3; thus 
the temperature of the skin falls nine degrees as that of 
the air falls thirty. The cooling effect of breezes he 
calculated at about one degree F. for each mile per 
hour; the effect of insolation at about one-fifth of the 
difference between the shade and sun temperatures, the 
latter being read on the black bulb in vacuo. 

1 Quoted from Hann, Klimatologie, Vol. I. 



16 THE CLIMATIC TREATMENT OF CHILDREN 

Thus, on a very hot summer day, with the tempera- 
ture at 100 in the shade, and a ten mile breeze, the sensi- 
ble temperature, according to Vincent, is 90; in the sun, 
with the black bulb registering 150 degrees, -it runs up to 
100. On a cold winter morning, registering zero, the 
sensible temperature is 70 degrees if the atmosphere be 
calm, falls to "60 in a ten-mile breeze, but may again be 
raised ten points by seeking a sunny spot, where the 
black bulb records 50 degrees. 

Vincent does not seem to recognize the importance 
of the relative humidity; he very wisely does not allow 
for clothing, whose influence 'is beyond accurate calcula- 
tion. It is interesting to note that, according to Vin- 
cent's formula, the cutaneous temperature, when that 
of the atmosphere stands at 80, registers about 94 
degrees, the indifferent temperature in water, and to 
observe the agreement with the empirical data set down 
on pages 7 and 8. 

Harrington's method of determining the sensible tem- 
perature is the more generally practical of the two; it 
recognizes the importance of the relative humidity, and 
the whole subject is of relatively little interest at those 
low temperatures where the wet thermometer becomes 
less reliable unless employed by specially trained ex- 
perts. For the amateur, the hair hygrometer is a 
sufficiently useful instrument, and in combination with 
the table just given is adequate to meet all ordinary 
requirements. 

As to Vincent's methods, the determination of the 
sun temperature can be made only with the black-bulb- 
in-vacuo thermometer, which requires some experience 
in handling; exposure of an ordinary thermometer to 



GENERAL PRINCIPLES 17 

the sun's rays gives results that are quite worthless, for 
even such trifles as the thickness of the glass and the 
shape of the bulb affect the readings materially. The 
wind correction is still more difficult of application, for 
while measurements on the towers of the weather sta- 
tions may easily be made very accurate, they give no 
idea of the actual air movement on the irregular surface 
of the earth, where alone we are exposed to the winds, 
and their gauging is quite impossible. Vincent's method 
will therefore remain of only academic interest, though 
its theoretical value is indisputable. A combination of 
both his and Harrington's would probably cover the 
ground most thoroughly of all. All the other plans for 
determining the temperature, as actually felt, are far 
too complicated for general use, as they invariably call 
for the mastering and employment of complicated 
mathematical formulae. 

Cloudiness. Excessive cloudiness is an objectionable 
climatic factor; it is not only a psychical depressant, 
but cuts off much of the beneficial effect of sunlight, to 
be noted presently; a ratio of cloudiness exceeding 70 
per cent, of the possible total impairs a climate very 
seriously. So high a proportion is not uncommon in 
many parts of the temperate zone during the winter 
months; just then, however, the shortness of the day 
renders sunshine none too abundant even in fine weather, 
so that any loss through cloudiness is an important mat- 
ter. Apart from this aspect of the case, which is largely 
psychical, we must devote a few lines to a discussion of 
the widespread belief that a lack of sunshine favors the 
dissemination of infectious diseases; there is probably 
some justification for this opinion, but the influence of 



18 THE CLIMATIC TREATMENT OF CHILDREN 

cloudiness on disease has been exaggerated. Ruhemann* 
seemed to present a strong case, when he attributed 
the prevalence of influenza in Berlin in January, 1900, 
to the almost total absence of sunshine, there having 
been only ten hours during the entire month, 2J per cent, 
of the possible total, whereas the normal proportion for 
that place is 14 per cent. This last allowance is assured- 
ly little enough, and exceeded almost everywhere in 
temperate North America, save perhaps at a few points 
on the south shore of Lake Ontario. Yet , if Ruhemann's 
contention were sound, our Middle Atlantic Coast, with 
an average allowance of 135 hours of sunshine in Janu- 
ary, 45 per cent, of the possible total, should be almost 
immune to epidemics of this disease. Anders, 2 more- 
over, in a comprehensive analysis of this subject for 
Philadelphia, showed clearly that cloudiness and influ- 
enza bear no intimate relation to each other. It is also 
a recorded fact that our first and most violent outbreak 
of this disease took place in the phenomenally mild, 
sunny and almost spring-like winter of 1889-90. Thus 
no true point of contact can be proved, and the effect 
of cloudiness on epidemic disease remains indetermin- 
able. Still, sunshine is of indisputable value in winter 
in elevating the temperature during the day, and giving 
the individual basking in it the benefit of direct heat and 
light radiation; its germicidal usefulness will be touched 
upon presently. 

There is a reverse side to this question, little appre- 
ciated, but not hard to understand. There is, particu- 
larly in summer, such a thing as .too much sunshine; 

1 Berliner klinische Wochenschrift, February 26, 1900. 

2 Journal of Balneology and Climatology, October 1902. 



GENERAL PRINCIPLES 19 

during the warm season, a little relief through the inter- 
vention of clouds is often grateful. We shall have occa- 
sion to return to this subject, and mention here only 
that the almost cloudless climates are quite as irritating 
as the gloomy ones are depressing; an excess of every- 
thing, even fine weather, ceases at last to be either attrac- 
tive or healthful. 

We may refer again to the psychical effect of cloudi- 
ness and its absence, which may be ignored in a healthy 
person, but is of some account in an invalid. A clear 
sky is distinctly stimulating, a cloudy one as positively 
sedative ; the mixed conditions characterizing our east- 
ern spring and summer seem to be the most generally 
beneficial. This matter is of relatively little importance 
in such sections as our Atlantic Coast, where the seasons 
differ but slightly in this respect; in most regions, how- 
ever, they are unquestionably of great moment, and well 
worth consideration, as any one can convince himself 
by spending a year in our lower Lake Region or in central 
Europe. 

Rain, Snow and Fog. An ample rainfall, if not too 
frequent, and well distributed through the year, is al- 
ways a good climatic feature, as it purifies the air and 
checks the formation of dust. The amount of rain on 
any one occasion is almost immaterial, provided it be 
sufficient to fulfill this purpose; its duration is more 
important, since an excess of rainy weather interferes 
with outdoor exercise, and acts as a psychical depressant 
even more than mere cloudiness. 

Most cool climates have a relatively small precipita- 
tion during the winter; as little moisture is required 
a,t low temperatures, owing to the small amount of 



20 THE CLIMATIC TREATMENT OF CHILDREN 

evaporation, this is of no consequence and perhaps even 
advantageous, for a wet winter is invariably productive 
of mud and slush. More important is the consideration of 
such regions as have a dry summer. If rain be totally 
absent, the air and dust undergo a certain amount of 
sterilization by drying; the annoying clouds of pulverized 
matter, that penetrate through the finest crevices, are 
at any rate shorn of some of their power for mischief. 
A hot and merely dry summer, however, is an almost 
unmitigated evil, for the amount of moisture is insuffi- 
cient to lay the dust on the one hand, and ample for the 
maintenance of- bacterial life and development on the 
other; such a summer climate is almost always unwhole- 
some. 

In cold climates, a permanent winter snow-sheet is in 
every way desirable; it facilitates travel and an outdoor 
life, and keeps the air pure by making dust impossible. 
This winter snow-sheet has but one drawback; it is apt 
to melt rather suddenly in early spring, turn the coun- 
tryside into a quagmire, and render the air exceed- 
ingly damp and chilly. Where the winter temperatures 
fluctuate about the freezing point, and the cold weather 
is intermittent, such sloppy and damp conditions may 
be expected during a considerable portion of the cold 
season; it is therefore best to avoid this type of winter 
climate altogether, if the total precipitation is at all 
large; the steadier, if more severe, cold farther north is 
in every way preferable. 

There are two kinds of fog. The first comes in from 
the sea, is relatively mild in winter and cool in summer; 
as it creeps inward it grows denser in the former season, 
but becomes dissipated in the latter. This type of fog 



GENERAL PRINCIPLES 21 

is wholly objectionable, if at all frequent, and mars many 
an otherwise desirable seaside resort. The fog that 
forms over valleys and plains on calm nights is perhaps 
less harmful, for, even in winter, the accompanying 
absence of wind partly compensates for the dampness. 
In cities like .London, however, where the cold winter 
fog becomes so loaded with soot as to be impenetrable 
and suspend all traffic, it is injurious in a high degree, 
regularly causing an upward leap in the death-rate. 

Winds. Steady and moderate air currents are essen- 
tial to a wholesome climate, but a good deal depends on 
the season, and strong winds that might be agreeable in 
summer become most unpleasant and even harmful in 
winter. Calms are not very desirable, being the chief 
cause of the second species of fog, as well as of frost, both 
of which are due to rapid radiation from the earth's 
surface on clear and quiet nights. •The temperature, on 
such occasions, rapidly falls to the dew-point, and. the 
atmospheric moisture is condensed. We can under- 
stand that such mists and fogs form most readily in sur- 
face depressions and mountain-bordered valleys; such 
sites are therefore to be shunned, and hillsides to be 
chosen in preference. 

Frequent and violent storms are objectionable in every 
way, and regions subject to cyclones, tornadoes or nu- 
merous thunderstorms are utterly unsuited to invalids. 
Thunderstorms, in particular, act as a powerful mental 
and physical excitant, and are extremely trying to many 
neurotic subjects. Even aside from true storms, con- 
tinuous high winds are very injurious to invalids, though 
often merely bracing to robust persons; the cold winds 
of the mistral type, that prevail on a hilly coast with a 



22 THE CLIMATIC TREATMENT OF CHILDREN 

cold hinterland, are the worst of all, but the high dust- 
laden winds of summer on the Great Plains are nearly 
as bad. An important exception may, however, be 
made in favor of the summer sea breeze; even if occa- 
sionally violent, it nevertheless brings with it the even 
temperature and pure air of the ocean, and is therefore 
tolerable and even salutary, unless it attains the force 
of a gale, as often happens on our North Pacific Coast. 

Hot winds are a direct excitant, and altogether harm- 
ful. It is customary for the dwellers in the desert or 
semi-arid West to laud the dryness of the heat, but 
much of the advantage conferred by the low humidity 
is neutralized by the furnace-blasts that make such 
regions a veritable inferno whenever the thermometer 
rises toward 100 degrees in the shade. It also is not 
true that these conditions are perfectly safe; the con- 
trary is evidenced by the frequency of heat-stroke 
in India during the very dry hot season, which closely 
resembles the summer of our own extreme Southwest. 

It is, of course, hardly necessary to warn invalids, 
especially if neurotic, against taking up their abode in 
regions where every spell of sultry weather leads the 
natives to scan the western horizon for funnel-shaped 
clouds, and think of their tornado-cellars; one might as 
well ask a patient to choose a residence on the side of 
an active volcano, and expect him to do well in spite of 
the constant nervous strain to which he will necessarily 
be subjected. 

The Atmospheric Pressure. The fluctuations of the 
atmospheric pressure at any fixed level, ranging as a rule 
within two or three inches of mercury, are of little physi- 
ological importance, but the variations according to 



GENERAL PRINCIPLES 



23 



altitude are sufficiently great to call for extended discus- 
sion. Removal of an individual to a higher or lower 
level furnishes an effective method of applying so-called 
pneumatotherapy, though its range is here somewhat 
limited, and its value eventually lost by acclimatization. 
The inhabitants of regions near the sea level can, of 
course, avail themselves of higher levels only, for the 
purpose of breathing rarefied air. Those who have dwelt 
at medium altitudes may either ascend or descend, in the 
latter event obtaining such benefits as may be afforded 
by the respiration of compressed air. The latter aspect 
of this subject has hardly been studied at all, and the 
transfer of patients from the mountains to the seaside 
has hitherto been employed but rarely, and with little 
definite purpose. 

The average air pressure at various levels, reduced to 
the temperature of 32 degrees, is as follows : 



Elevation, 
Feet 


Pressure, 
Inches of Hg. 


Elevation, 
Feet 


Pressure, 
Inches of Hg. 



2,500 
5,000 
7,500 


30.0 
27.3 
24.8 
22.4 


10,000 
12,500 
15,000 


20.3 

18.3 
16.5 



Thus, removal to the elevation of 5,000 feet deprives 
the individual of one-sixth of his normal supply of air, 
and an additional 5,000 feet cut off another sixth. So 
great a change must necessarily entail important physi- 
ological consequences, which it will be worth our while 
to study with some minuteness. 

The Physiology of High Elevations. Viault, 1 in the 
course of a scientific tour in the Andes, was the first to 

1 Comptes rendus de l'acadeuiie des sciences, Vol. 111. 



24 THE CLIMATIC TREATMENT OF CHILDREN 

demonstrate the remarkable blood changes at high ele- 
vations; he found that the dwellers at an altitude of 
14,400 feet exhibited an increase in the number of red 
blood cells from 5,000,000 to $,000,000 to the cubic 
millimeter. Egger 1 made similar examinations at Arosa, 
in the Alps, 5,900 feet above the sea; his observations 
showed a gain of only 2,000,000 red blood cells. Wolff 
and Koeppe 2 then proceeded to examine their patients 
at Reiboldsgriin, 2,300 feet high; they reported an 
increase of only 1,000,000. These observations, which 
have obtained ample confirmation by other investigators, 
show an inverse ratio between the air supply of the 
individual and the number of erythrocytes in his blood. 
For a time, certain critics made claim that this increase 
was only apparent. Grawitz 3 asserted that concentra- 
tion of the blood through increased transpiration of the 
body fluids fully accounted for the relative numerical 
increase of the suspended corpuscles at high elevations, 
the actual change being a diminution of the plasma. It 
is not difficult to offer a. simple and final objection to 
Grawitz's explanation; no loss of body weight or fluid 
takes place at high levels, as would be inevitable in 
case of increased transpiration; as a matter of fact, 
the lower temperature at elevations tends to check 
perspiration, not increase it. Gottstein 4 urges that the 
apparent increase in the number of erythrocytes rests 
on a fallacy, and that the Thoma-Zeiss apparatus, the 
one regularly employed, is adapted only to use at the 
sea-level. It is not easy to follow Gottstein's train of 

1 Correspondenzblatt fur schweizer Aerzte, 1892, p. 645. 
2 Mtinchener med. Wochenschrif t , 1893, No. 11. 

3 Berliner klin. Wochenschrif t, 1895, Nos. 33 and 34. 

4 Allgemeine med. Centralzeitung, 1897, No. 74, 



GENERAL PRINCIPLES 25 

thought, but if he supposes that the density of the blood 
serum is materially affected by the atmospheric pressure, 
he exhibits a strange ignorance of the laws of hydraulics, 
for liquids are so slightly compressible, that the error at 
10,000 feet does not amount to more than 0.001 of one 
per cent, for a watery fluid like blood-serum; in other 
words, it is infinitesimal. 

It is difficult to avoid the conclusion that the whole 
matter is merely a compensatory hypertrophy of the 
blood tissue, in response to the extra work imposed 
upon it. The first point sustaining this view is the 
almost exact inverseness of the ratio of air to blood-cells, 
but the best evidence in favor of the hypertrophic theory 
is furnished by the gradual development of the cellular 
increase, and the concomitant, but somewhat tardier, in- 
crease in the. amount of haemoglobin. The observations 
made by K undig 1 at Davos give the following result : 



Amount of Increase of 


Erythrocytes 


Haemoglobin 




11.1% 
16.3% 
21.3% 


7 4% 




14 1% 




20.5%, 







It is clear that removal to a considerable elevation 
acts also as a general stimulant to metabolism, for so 
extensive an hypertrophy of the most important tissue 
of the body, namely, the blood, must inevitably react 
upon the entire organism. It necessarily follows that 
a sudden and extreme change of level is not suited to 
every constitution; the strain imposed during the first 
three weeks may be too great for a person suffering from 
impaired general vitality; on the other hand, it is plain 

1 Correspondenzblatt fur schweizer Aerzte, 1897, p. 2. 



26 THE CLIMATIC TREATMENT OF CHILDREN 

that a gradual ascent will frequently obviate this diffi- 
culty. After a four weeks' stay, it is possible to decide 
definitely whether the locality selected is or is not 
salutary to the individual under observation. 

A circumstance, noted by Weinzirl, 1 and hitherto 
unexplained, is an excess of about 500,000 erythrocytes 
in winter, as compared with summer; the place of ob- 
servation was near Albuquerque, N. M., at about 6,000 
feet elevation, but, somewhat curiously, higher in the 
summer camp than in winter quarters; we should have 
expected exactly the opposite change. We cannot, how- 
ever, entirely exclude errors of observation, and his 
report is somewhat fragmentary. 

Observers seem to agree that high-level residents 
show as a permanent condition a somewhat increased 
oxygen inhalation and carbohydrate metabolism. The 
former is in accord with the increased amount of haemo- 
globin, the latter is an inevitable consequence of the 
former; both become especially marked when vigorous 
exercise is indulged in (Biirgi). 2 

Mountain Sickness'. An excessively abrupt and ex- 
treme transfer from a low to a high level brings on the 
symptoms characteristic of an acute anaemia, precisely 
similar to that resulting from a profuse haemorrhage. 
It affects individuals to a varying degree, those previously 
anaemic naturally suffering more readily and acutely 
than the robust. At the height of 16,000 feet, where 
the supply of air is just one-half of that at the sea-level, 
even the most sturdy person will succumb, if he ascends 
to this height rapidly and by means of the arduous 

1 Amer. Journ. of the Med. Sciences, August, 1903. 

2 Archiv fur Anatomie und Physiologie, 1900, No. 506. 



GENERAL PRINCIPLES 27 

exertion of climbing. Whymper, 1 seasoned as he was by 
the most strenuous Alpine tours, practically collapsed 
at the stated level in the course of his first ascent of 
Chimborazo, having approached that mountain rather 
rapidly from the Pacific Coast; after a rest of some days, 
he accomplished the final climb to the summit (21,000 
feet), but with difficulty. Later on, being then quite 
accustomed to the rare atmosphere of the Ecuador 
plateau (10,000 feet), he climbed the same mountain, as 
well as others, without any noteworthy distress. 

It is now generally agreed that Egger 2 is right when he 
claims that mountain sickness is nothing more than the 
expression of a relatively acute anaemia; as this anaemia 
disappears in the course of the hypertrophy of the blood 
elements, the distressing symptoms gradually vanish. 

Phototherapy at High Elevations. Nowadays, when the 
study of radiant energy and its therapeutic application 
is so much in the foreground, we cannot discuss high 
altitudes without referring to the peculiar modification 
of the solar rays at these levels. The radiant emana- 
tions — or undulations — from the sun, in passing through 
the terrestrial atmosphere, encounter a highly absorptive 
medium; their absorption is partly due to the fact that 
air is a complicated and not uniform gaseous mixture, 
not a pure gas, but is caused chiefly by the presence in 
the air of a large and unevenly distributed amount of 
watery vapor. All the solar rays are affected to some 
degree, but the ultra-violet most of all; as the ultra- 
violet rays just now occupy the center of the stage, we 
shall consider them first. The following table, after 

1 Travels among the Great Andes of the Equator, New York, 1892 

2 Loc. cit. 



28 



THE CLIMATIC TREATMENT OF CHILDREN 



Bunsen and Roscoe, 1 shows the proportion of chemically 
active rays reaching the surface of the earth, at various 
levels and sun altitudes, in percentages: 





Elevation, 
Feet 


Altitude op Sun 




70 deg. 


50 deg. 


30 deg. 


o 


42% 
47% 
53% 
59% 


34% 
39% 
46% 
53% 


19% 
24% 
30% 

37% 


4 000 


8,000 


12,000 





Saake 2 showed, in a recent communication, that the 
atmospheric radioactivity at Arosa (5,900 feet) is three 
times that in the lowlands, and points to a possible 
relationship between this circumstance and certain 
therapeutic results in tuberculosis, one of the many 
affections now being subjected to radiotherapy. It is 
also more than likely that the excess of ultra-violet rays, 
at high elevations, is responsible for the liability to sun- 
burn to which mountain-climbers are exposed. It is, 
at any rate, certain that the reflection from snowfields, 
formerly regarded as the exciting cause, is not essential, 
for Langley 1 suffered severely from sunburn in his ascent 
of Mt.. Whitney (14,600 feet), though his route led 
entirely over rocks. 

More apparent, and therefore more striking, is the 

proportion of solar heat that escapes absorption at high 

altitudes. The sun-thermometer gives higher readings 

in the upper Alps, than at their foot, though the shade 

temperature is much higher below. This advantage is 

enhanced in winter by the coincidence that the high 

valleys suffer less from clouds and mist than the foothills. 

We can readily understand from this how visitors to the 

1 -Quoted from Hann, Klimatologie, Vol. I. 

2 Miinchener medizinische Wochenschrift, 1904, No. 1. 



GENERAL PRINCIPLES 29 

Engadine and Colorado can go about in the sun quite 
lightly clothed at shade temperatures well below the 
freezing point. 

The field for the application of a mild photo- and 
radiotherapy at high elevations is therefore quite exten- 
sive, and well worth further development. Little has, 
however, been done so far, as the more powerful and 
tangible forms of radiant energy have hitherto almost 
monopolized the interest of the scientific world. 

The Temperature at Elevations. In theory, the fall of 
temperature in ascending from the sea level is governed 
by a well-defined law; practically, however, modifying 
factors step in. The chief exception is due to what is 
called the inversion of temperature, in rugged regions 
where intense cold may reign in the deep valleys while 
the mountain-sides are basking in a mild sunshine. In 
some districts this phenomenon is quite temporary; in 
others it is apt to prevail for days at a time during the 
presence of a persistent high barometric area, especially 
when the ground is snow-covered. 

The effect of altitude on the daily range of tempera- 
ture varies. On towers or isolated peaks, the daily 
range is very much diminished, for much of the diurnal 
radiation from the earth is lost; the reduction amounts 
to as much as four degrees on fine days on the roofs of 
our loftiest sky-scrapers. The temperature does not 
continue to rise until three or four o'clock, but begins to 
fall as early as two or even one p.m. On high plateaus 
the case is quite different; the radiation from the earth's 
surface is even greater than on low plains, because of 
the rarer atmosphere, and, as stated before, the solar 
radiation is also relatively great ; the result is ah absolute 



30 THE CLIMATIC TREATMENT OF CHILDREN 

, increase of the daily range as compared with the lower 
situations. 

The seasonal range regularly diminishes with the alti- 
tude, very rapidly in rugged districts, where the deep 
valleys are the seat of frequent inversion of temperature 
in winter; more slowly on continental elevations, where 
inversion is not conspicuous. At the height of only a 
few miles the difference between summer and winter 
becomes quite insignificant. 

We may here append a few figures. On mountain 
peaks the fall of temperature is about three degrees per 
thousand feet, measured from the sea level. Plateaus 
are relatively warm, the temperature then falls with 
increased rapidity to the surrounding summits. Inver- 
sion of temperature often causes a marked diminution 
of the fall upward, especially in winter, when the 
mountain slopes may be warmer than the valleys for 
weeks at a time. The dynamic warming and cooling of 
the air currents in descending and ascending, respectively, 
amount to five degrees per thousand feet, and the pre- 
dominance of one or the other flow materially affects 
local averages. As descending currents are common in 
winter, but infrequent in summer, the fall o*f tempera- 
ture as one goes upward averages very much greater 
in the latter season. 

The Seashore. I shall here refer only briefly to the 
peculiarities of marine climates, as the various details 
will receive ample illustration later on. The seaside is 
damper than the interior in summer, owing to the fre- 
quency of sea breezes ; it is often a little drier in winter, 
but only relatively, because the air is warmer and less 
readily saturated. ' This distribution of humidity is 



GENERAL PRINQIPLES 



31 



directly responsible for a similar one of cloudiness; to a 
lesser extent, this is also true of the precipitation, but 
here so many other factors step in that any rule would 
present numberless exceptions. The extremes of tem- 
perature are invariably modified by the presence of large 
bodies of water, an expanse of even thirty or forty miles 
producing a considerable effect; much depends on the 
prevailing wind direction. 

The summer is invariably retarded along the coast, 
still more on islands; the winter is sometimes retarded 
even more, sometimes very little, local factors modify- 
ing the rule in many instances. For example, mid- 
summer falls on the 20th of July on the Delaware River, 
on the 25th at New York City, on the 1st of August on 
southern Long Island, and on the 5th at Block Island; 
in winter, however, the retardation is barely a week in 
all. At Bermuda the mid-seasons fall on the middle of 
February and August respectively, whereas the Farallone 
Islands, off California, give February 1st and September 
15th as the corresponding dates. 

The average annual temperature at the seaside is ele- 
vated northward, depressed southward; the annual and 
daily ranges are very much reduced, especially where 
sea breezes predominate. It will be of interest to 
glance at a comparison of Baltimore (suburban) and 
Atlantic City, which lie on the same parallel, for the 
same period. 





Jan 


Feb 


Mar 


Apr 


May 


Jun 


July 


Aug 


Sep 


Oct 


Nov 


Dec 


Yr. 


Baltimore . 
Atlan. City 


32.8 
32.5 


34.9 
33.9 


40.1 
37.6 


51.6 
46.8 


62.6 
57.2 


71.8 
66.8 


75.6 
71.9 


73.4 
71.8 


66.5 
66.7 


55.6 
56.3 


44.2 
44.7 


36.4 
36.4 


53.8 
51.9 


Difference . 


-0.3 


-1.0 


-2.5 


-4.8 


-5.4 


-5.0 


-3.7 


-1.6 


+0.2 


+0.7 


+0.5 


0.0 


-1.9 



Atlantic City is only semi-oceanic, as land breezes 



32 THE CLIMATIC TREATMENT OF CHILDREN 

prevail at all seasons, except occasionally between April 
and August; the reason for giving suburban data for 
Baltimore will be stated in the next chapter. In this 
semi-southern latitude (39.4) the ocean already lowers 
the annual average materially; the daily range is seven 
degrees less at Atlantic City from April to October, only 
three from November to March, the transition in spring 
and autumn occurring quite abruptly. 

The annual range is 37 degrees at Nantucket, Mass., 
and 45 at Scranton, Pa., on the same parallel. Farther 
north we find a range of 43 degrees in Nova Scotia 
(only 33 on Sable Island) and 56 in the St. Lawrence 
Valley. 

The wind velocity is about 50 per cent, greater on the 
coast than inland, two or three times as great on flat 
and small islands. This feature should never be dis- 
regarded in recommending marine climates; it is mark- 
edly diminished only a few leagues inland, unless the 
coast be exceptionally flat. The number of rainy days 
agrees quite well with the percentage of cloudiness, and 
does not correspond with the total amount of precipita- 
tion; some coasts are therefore subject to drizzling 
rains, others to torrential downpours: 

The saline constituents of the sea air are minute in 
quantity, and of more than doubtful medical importance ; 
we shall have occasion to recur to this subject later on, 
and here mention merely the widespread exaggeration 
of its value. 

The Classification of Climates. For therapeutic pur- 
poses we may classify climates, first, according to the 
temperature ; secondly, according to the relative humid- 
ity; thirdly, according to the altitude. 



GENERAL PRINCIPLES 33 

A convenient classification according to temperature 
is that of Koppen, 1 here slightly modified: 

1. Hot climates. Every month averages higher than 
68 degrees. 

2. Warm climates. Every month averages higher 
than 50 degrees, one or more exceed 68. 

3. Truly temperate climates. All months average 
between 50 and 68 degrees. 

4. So-called temperate climates. The monthly aver- 
ages range from below 50 to above 68 degrees. A 
better name would be " extreme climates." 

5. Cool climates. All months average below 68 de- 
grees, one or more below 50. 

6. Cold climates. Every month averages under 50 
degrees. 

The fourth group is so very extensive in point of terri- 
tory covered, as well as so rich in minor variations, that 
it may. advantageously be sub-divided as follows : 

4a. Warm temperate. Averages below 50 degrees 
are limited to the winter months. 

4b. Middle temperate. The most extreme of all. 
More than three months both fall below 50 and exceed 
68 degrees. 

4c. Cool temperate. Averages above 68 degrees are 
limited to the summer months. 

If we classify climates according to the relative 
humidity, we may form the following divisions : 

1. Desert climates. Humidity under 40 per cent. 

2. Dry climates. Humidity between 40 and 60 per cent. 

3. Moderately moist climates. Humidity between 
60 and 80 per cent. 



1 Meteorologische Zdtschrift, 1884. 



34 THE CLIMATIC TREATMENT OF CHILDREN 

4. Very moist climates. Humidity over 80 per cent. 
We must not forget that many localities vary according 
to the season, belonging to one class in winter, and to 
another in summer. As a rule, spring and summer are 
the driest seasons, but at many marine stations summer 
is much damper than winter. The tendency to a dry 
spring and moist autumn is almost universal in the 
temperate zones. 

The third classification, according to elevation; is the 
one on which there is most nearly a universal agreement; 
it has been settled to designate as low levels all those 
under 1,000 feet; those up to 3,000 feet may be called 
moderate elevations ; above that, high levels. 

The summary of these three methods of classification 
gives an array of varieties that is almost bewildering; 
even though some combinations do not actually occur, 
still the total is very great. We cannot attempt to 
unravel this apparent tangle until we have given an 
outline of the climatic types that have a definite value 
in therapeutics; when this has been done, a systematic 
grouping will present no special difficulty. 

General Application. With the above immense variety 
of climates at our disposal, we nevertheless realize at 
once that their applicability lies within readily defined 
limits. We have already excluded the hot climates 
from the field of therapeutics, and some of the others are 
also objectionable at certain seasons, or useless for par- 
ticular purposes. We must, furthermore, regard the 
previous habituation of the individual applying for treat- 
ment ; for changes of climate are, to a certain extent, 
relative. The general proposition may be concisely 
stated as follows : 






GENERAL PRINCIPLES 35 

Residents of hot and warm regions may profitably 
avail themselves of a measure of climatic training by 
removal to a cooler region; it is impossible to spare their 
organs by the employment of a warmer climate; this 
involves no appreciable change for them, and they are 
apt to come to us already somewhat enervated. 

The inhabitants of temperate regions may avail them- 
selves either of sedative treatment in a warm climate, 
or of bracing conditions in a cool one; they thus enjoy 
more extensive opportunities. In the climates that I 
.have designated as truly temperate, the very evenness 
is likely to cause some enervation; here a visit to a cool 
region is sure to do good. The same treatment is often 
also desirable in the summer months of the extreme 
climates; the residents in many extreme climates have 
in fact two bad seasons to contend with, namely, a hot 
and enervating summer, and a winter that keeps the 
less robust indoors much of the time; here the field of 
climato therapy may be very extensive indeed. 

So far as temperature goes, the only climatic treatment 
that the inhabitant of a cool region is likely to require 
is removal to a mild winter resort. This may be chosen 
so as to have either a sedative or a training effect, and 
here a high degree of professional skill will be well 
rewarded, whereas mere routine management may do no 
end of harm. 

The residents of cold climates are largely excluded 
from the benefits of climatotherapy. Change of climate 
necessarily means to them increased warmth; this inevi- 
tably involves the dangers incident to at least relative 
enervation, which will make a return to their former 
homes perilous. The risks of permanent removal from 



36 THE CLIMATIC TREATMENT OF CHILDREN' 

a cold to a mild region are illustrated by the sad fate of 
the Cape York Eskimos in the far from genial climate of 
New York City; the results are even worse than those 
attached to a transfer from New York to the tropics. 
Thus the inhabitants of cold countries must seek health 
within their own climatic range. 

On the other hand, the benefits often derived from a 
higher elevation are not limited to the inhabitants of 
any zone; such limitations as exist are strictly individual, 
and will be pointed out later on. The effect of a dry, 
as opposed to a moist climate, has been gone into so fully 
as to require no repetition here. 

Application to Childhood. The above rules require 
material modification in adapting them to infants and 
children. First and foremost, children are far more 
sensitive to cold and temperature changes than adults; 
we all know that their extremities become cold and even 
cyanotic at temperatures that are quite congenial to 
older persons. This difference must be regarded as 
normal, and is due to the following causes: In the first 
place, the protective accumulation of adipose tissue, 
aside from that peculiar to the milk-fed and inactive 
infant, does not usually- become extensively developed 
until well after puberty. Secondly, the child's meta- 
bolism is so largely devoted to the building up of new 
tissue, that a relatively small caloric surplus remains to 
meet adverse external conditions. Thirdly, the city 
child is, as a rule, deficient in that combination of resist- 
ing powers which we commonly call robustness; but 
here I must admit that my experience, though somewhat 
limited, does not speak for any universal superiority in 
this respect among country-bred children, compared with 






GENERAL PRINCIPLES 37 

those raised in large towns under reasonably good 
hygienic conditions. Urban sanitation is becoming so 
far superior to that of rural districts, in a number of 
respects, that the advantages of the latter, conspicuous 
some decades ago, are now less in evidence. Recently 
collected data seem to show, in addition, a marked 
physical deterioration in the rural population of some 
of our eastern states, which does not apply equally to 
most western sections. 

In later childhood, some of the sensitiveness to low 
temperatures, just outlined, is compensated by a greater 
physical activity and relatively elastic metabolism, 
shown by the enormous possibilities of the juvenile 
appetite. These reserve forces, however, can be drawn 
upon only intermittently, and are often gravely abused. 
Excessive strains in childhood are fertile sources of 
various organic weaknesses in later life; for an example 
I need not go further than to refer to the premature 
degenerative processes that follow the strenuous pursuit 
of" athletic sports by growing boys. In infancy the 
stated compensations are not at all available, and the 
same is true, in a gradually diminishing degree, up to 
about the seventh year. Until the age of one-and-a- 
half to two years, exercise cannot, of course, be counted 
on at all, and after that, for some years more, its role 
increases only very slowly; in this direction there is 
fortunately no great danger of injury from trying to 
overdo matters. On the other hand, any attempt to 
stimulate the metabolism of young children to abnormal 
activity by forced feeding is certain to result in disaster ; 
the digestive functions break down at once in infancy, 
more slowly, but just as surely, in young children; thus 



38 THE CLIMATIC TREATMENT OF CHILDREN 

this resource, valuable as it often becomes in later life, 
is absolutely barred in infancy and early childhood. 

Later childhood would probably present a gradual 
transition from the extreme sensitiveness of early life to 
the greater hardiness of maturity, if new adverse factors 
did not come into play in the seventh year. A child of 
that age may have become quite sturdy and robust, and 
able to resist unfavorable external conditions fairly well, 
when it is suddenly deprived of the best part of its time 
for outdoor play by the demands of the school. This 
matter would not be so bad if the trying school regime, 
with its severe physical discipline, were made to act on 
the youthful organism gradually, beginning with two 
and three hour sessions during the first year or two. 
Here, however, the child's physical welfare obtains scant 
consideration; iron-clad school regulations, as well as 
the desire of selfish or busy parents to have their children 
out of the way, are paramount; so we see fairly hearty 
children rapidly becoming flabby and anaemic as their 
best time is spent indoors, the care of their bodies being 
entirely sacrificed to an ostensible zeal for intellectual 
development. As a matter of fact, most of the time 
spent in school during the first year or two is wasted in 
the worst possible way; with the customary unwieldy 
classes a child spends the whole day in acquiring but a 
small modicum of knowledge. The young mind con- 
fessedly can grasp but few facts at a time, yet, to instill 
that minimum, the greatest part of the day is spent in a 
stuffy- schoolroom. It is only too well known that, in 
our great cities, the early acquirements of school-chil- 
dren consist chiefly of one or more of the infectious 
diseases, besides vicious habits of eating in the form of 



GENERAL PRINCIPLES 39 

the bolting of food and the ingestion of portentous 
masses of cheap and harmful confectionery, usually sup- 
plied by a dealer conveniently located next door to the 
school. School life thus implies a distinct set-back in 
the physical condition of the child, the progress that 
would be expected with advancing years is not realized. 

We have seen the disadvantages under which children 
labor in the effort to adjust themselves to low tempera- 
tures; the net result is an elevation of the indifferent 
temperature as compared with adults. We must there- 
fore modify materially the general scheme of climatother- 
apy in applying it to children, and, in almost all cases, 
select warmer regions for the very young than would 
be either required or desirable in treating older persons. 

Above the indifferent point, the variations due to age 
are equally marked; children, especially young infants, 
tolerate great heat very badly. Older children, to be 
sure, indulge in lively play in the sun, at temperatures 
quite unendurable to their elders, but we have no reason 
to regard this sort of exposure as harmless. It is true 
that typical heat-stroke is rare in children, but this is 
chiefly because the heart and kidneys, which are charged 
with the duty Of combating the tendency to hyperpy- 
rexia, are still undamaged by the accumulated wear and 
tear of many years, and by chronic intoxications such 
as alcoholism. Still, everything considered, even if we 
make allowance for the elevation of the indifferent point 
in early life, we may safely assume that prolonged and 
violent exercise at a shade temperature of 95 degrees, 
and a sensible temperature of 80, both of which are com- 
mon during our hot spells, is very injurious to young as 
well as older children. 



40 THE CLIMATIC TREATMENT OF CHILDREN 

It is well known, that children of white parentage do 
very badly in the tropics near the sea level; the regions 
bordering on the temperate zone, having a somewhat 
lower temperature in the dry season, as well as elevated 
sites, are often very much less dangerous, but, at their 
best, deprive the children, as they grow -up, of the 
physical training afforded by cool weather. In all cases 
that do not succumb in early life, there is marked enerva- 
tion and a low power of resistance to morbific influences 
of all kinds. . ' . 

As to elevations, there is some diversity of opinion. 
European observers discountenance the sending of chil- 
dren under six or eight years of age to the higher 
Alps; as the July temperature there averages only in the 
fifties, their attitude is quite correct, for young children 
and infants require a much warmer summer climate. 
In our Rocky Mountains this objection does not apply, 
and fairly robust children, even those of tender years, 
accommodate themselves quite readily to the consequent 
blood changes and heightened metabolism. As to mid- 
dle elevations, there is more agreement; an altitude 
of 1,500 to 2,000 feet is certainly beneficial to all save a 
few greatly enfeebled children. It is worth mentioning 
that stimulation of the digestive functions is a much 
safer procedure in the pure, cool and somewhat rarer 
atmosphere of our eastern hills than at lower levels; a 
burdening of the stomach and intestines that would be 
hazardous at the seashore is well borne and even advan- 
tageous in the mountains. 

Climate and Disease. Many diseases are more or less 
uniformly distributed over the globe, and but slightly, 
if at all, influenced by climate; a considerable number 



GENERAL PRINCIPLE* 41 

are more or less modified by atmospheric conditions; a 
few are almost entirely subject to them, being absolutely 
limited to certain zones and seasons. 

The frequency and severity of digestive disorders in 
children are almost in a direct ratio to the temperature, 
more accurately, perhaps, the sensible temperature. 
They are relatively mild and uncommon in cool weather, 
but increase suddenly as the season grows warm, assum- 
ing an alarming distribution and seriousness when the 
indifferent temperature is passed. Chart I (see oppo- 
site), modified after Seibert, 1 illustrates this- point in 
telling fashion. It gives the number of deaths from 
diarrhceal diseases in New York City among children 
under the age of five years, and the mean temperature, 
by months. I have taken the liberty of adding the 
sensible temperature. 

The reader will observe that the rate of mortality 
remains uniformly low until the average sensible tem- 
perature reaches 55 degrees (middle of May); then a 
rapid rise occurs as the temperature goes up. A fairly 
rapid and continuous fall takes place as the season turns 
(end of July), but there is no complete remission until 
the mean sensible temperature again falls below 55 
(early October). Some of the slight excess in October 
is probably due to the eventual death of severe and 
chronic cases holding over from the summer. 

That the summer temperature of New York is very 
far above the danger point is also shown by the data 
for Berlin 2 , where the summer is about eight degrees 
cooler; July in Berlin having exactly the temperature of 

1 Med. Record, March, 1888. 

2 Berliner klinische Wochenschrift, 1904, p. 1163. 




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CHART II 



42 THE CLIMATIC TREATMENT OP CHILDREN 

September in New York. In hot summers, in Berlin, the 
deaths under the age of one year, which average about 
725 per month from January until May, increase to 850 in 
June, 1,310 in July, and 1,970 in August; in cool summers, 
which seem very cool indeed to an American, the figures 
are very much lower. It will be observed that in Berlin 
the maximum occurs in August, instead of July, as in 
New York; this is almost certainly due to the fact that 
the intense heat and high humidity in New York prove 
fatal to delicate and badly managed infants before the 
summer is half over, whereas the less extreme conditions 
in Berlin are more apt to lead to subacute and chronic 
affections, which prove deadly only when the heated 
term is prolonged into August. In hot years the figures 
for Berlin compare very unfavorably with those for New 
York, considering the vast difference in climate; on the 
other hand, we must not forget that improved infant 
hygiene has materially reduced the New York mortality 
in recent years, whereas in Berlin systematic warfare 
on the summer diarrhoea of infants by the health au- 
thorities is still only in its early stages. 

The figures for New York have been relatively low in 
recent years; among northern cities Boston and Detroit, 
both considerably cooler, furnish less favorable reports; 
the same is true of Philadelphia, where a somewhat 
warmer summer is compensated by better housing con- 
ditions. The large cities doing better than New York — 
namely, Chicago, Buffalo and San Francisco — are all very 
decidedly cooler in summer. For the rate of progress 
in New York, see Chart II (opposite). 

The reason for this terrible infant mortality in summer 
is in part the relatively feeble resisting power, previously 



GENERAL PRINCIPLES 43 

referred to; but a still greater part must be assigned to 
the staple diet of children, namely, milk, which so readily 
undergoes decomposition at moderately high tempera- 
tures. Thierf elder and Glinther 1 found that the lactic 
acid bacillus flourishes most luxuriantly at 82 degrees, 
exactly the mean summer temperature in the tropics, 
whereas its growth becomes totally arrested at 50 de- 
grees. The relation to our charted data is obvious, as 
is also the prophylactic indication. In a recent article 2 
I have endeavored to show, by means of a statistical 
investigation, that the greater part of the death-rate 
from infantile diarrhoea may be obviated by sanitary 
measures, such as have been widely adopted since the 
publication of Seibert's paper. The net results have 
been embodied in the preceding chart (II) ; it will appear 
that an effective reduction has been achieved within the 
past fifteen years, but that the limit is in sight, as our 
summers cannot possibly be rendered altogether innocu- 
ous. The few degrees of difference between our warmest 
and coolest summers play an unimportant role, for all 
range very far above the danger point, which stands at 
55 degrees when no precautions whatever are taken. 

On Chart II, as in the Berlin data, no attempt has 
been made at a classification of diseases, but, during 
the third quarter of the year, the overwhelming majority 
of deaths under one year are attributable to gastro- 
intestinal affections, either primarily or as a complication. 

The supposed tendency to respiratory disease in win- 
ter is more doubtful. We shall discuss the question 
of " catching cold" in a later chapter, and content 

1 Archiv fur Hygiene, 1897, vol. 25. 

2 New York Med. Journal, September 9, 1905. 



44 THE CLIMATIC TREATMENT OF CHILDREN 

ourselves, for the present, with stating that sudden 
temperature changes, as previously indicated, are more 
potent in setting up a disturbance in the respiratory tract 
than mere cold. We thus comprehend the established 
fact that pneumonia, at least in children, is commonest 
in the spring, and that the climates most associated 
with it lie well to the south. In Europe it is com- 
moner in central and southern Italy than farther to 
the north (Hirsch), and we are now thoroughly familiar 
with its relative rarity in cold regions like Greenland. 
In the United States the census reports regularly show 
an excess in the southeastern states, especially in such 
mild and still very changeable climates as that of 
Arkansas. Concerning the tropics, all travelers agree on 
the relative frequency there of this disease; in Angola, 
West Africa, for instance, the whole native popula- 
tion eventually succumbs to respiratory affections; one 
rarely sees an old man (Hann). The enervating effect 
of warm and hot regions is evidently an important 
factor. 

The rheumatic diseases, including valvular affections 
of the heart, appear to be more frequent in cold climates ; 
the same is possibly true of nephritis, but we have, at 
present, no means of verifying this belief. In the case 
of the last, the etiology is so complex that we cannot 
come to any sort of conclusion, and we must bear in 
mind -the higher diagnostic skill of the average prac- 
titioner in temperate regions, where fewer cases are 
likely to escape observation. 

Among infectious diseases there are a few that are 
so intimately associated with particular climates that 



GENERAL PRINCIPLES 45 

we must give them separate attention; as may be 
inferred from their biological relations alone they are 
all more or less peculiar to warm regions, or, at any rate, 
the warm season. In addition to infectious diseases 
proper, there is a group of affections dependent on vege- 
table toxins, which is similarly limited geographically, 
and from a similar cause; these diseases also call for 
consideration under this heading. To save space no 
diseases strictly confined to the tropics will be considered : 
we shall restrict ourselves to those that can and do at 
times invade the temperate zone, or are native there; 
those that interest us most are the insect-borne dis- 
eases in the first group, and so-called hay-fever in the 
second. ■ . 

The Insect-borne Diseases. - This group of diseases, 
almost limited to warm climates, is characterized by 
their mode of transmission through the bites of dipterous 
insects, and, so far as we know, the infecting organism 
inoculated belongs to the class Protozoa. Three of these 
diseases are now know r n to attack man, and are, with a 
single exception, quite thoroughly understood. 

Malaria consists in an infection with protozoa, of 
the class* Sporozoa, conveyed solely by species of the 
dipterous genus Anopheles. Judging from the present 
distribution of this disease, it is probably native to 
the Old World, having been brought to this hemi- 
sphere in the sixteenth and seventeenth centuries. 1 
Even now, it is less uniformly distributed on this side 
of the Atlantic Ocean than on the. other; many, por- 
tions of South America, well adapted to malaria, but 
more or less isolated commercially from the rest of 

1 See also Howard, Mosquitoes, New York, 1901, p. 93. 



46 THE CLIMATIC TREATMENT OF CHILDREN 

the world, are still only partially or not at all infected. 
The Only absolute barrier to the ubiquity of the 
anopheles, aside from the absence of stagnant pools, 
is a July temperature below 60 degrees. There is also 
a belt of relative limitation between that line and the 
July isothermal of 66 degrees, within which the pest is 
exterminated with relative ease, or tends to disappear 
spontaneously. Many regions within this belt have 
always been free from malaria, Quebec for example; 
others have become free, as southern England. 

The protozoon of tertian fever seems to flourish at 
a lower temperature than the organisms respectively 
responsible for quartan and sestivo-autumnal fever. For 
the latter forms the minimum temperature seems to be 
72 degrees, and in the United States they are rare north 
of the July isothermal of 75, whereas in southern Europe 
the former line is reached ; cases reported north of these 
limits always depend on casual importation. Whereas 
the annual epidemic of tertian fever begins in spring, as 
soon as the anopheles appears,, the pernicious fevers do 
not set in until the average temperature reaches 72 
degrees, as is exquisitely shown for Rome by all the 
local observers. Rainfall also plays an important part, 
for Jilek 1 shows that a wet spring precedes a severe 
epidemic, evidently on account of the increased forma- 
tion of puddles and marshes. The elevation required 
for exemption from malaria increases from north to 
south, the factor evidently being the summer tempera- 
ture; the limit is 3,000 feet in Italy and 6,000 in 
Colorado. The respective July temperatures at these 
levels are about 66 and 70 degrees; we must note, how- 

1 Ueber das Verhalten der Malariafieber in Pola, Vienna, 1881. 



GENERAL PRINCIPLES 47 

ever, that in Colorado the dryness of the climate is un- 
favorable to the mosquitoes. 

Yellow fever is caused by an organism, hitherto not 
identified, transmitted by mosquitoes of the genus 
Stegomyia, the life conditions of which are somewhat 
similar to those of the anopheles. It is noteworthy that 
these allied insects do not invariably occur together; in 
the city of New Orleans, for instance, the anopheles is 
not very common, while the stegomyia is exceedingly 
abundant. Howard 1 defines the northern limit of the 
stegomyia with considerable exactness, his line corre- 
sponding closely to the July isothermal of 78 degrees, 
which is also the limit of the Cotton Belt ; he admits that 
it is difficult^ under these circumstances, to account for 
the terrible epidemics that ravaged Philadelphia and 
New York a century ago; if his data are correct, a 
recurrence of such disasters is now impossible north of 
Virginia and the southern tip of Illinois. By way of 
contrast to malaria, yellow fever is unquestionably native 
to tropical America, . and has hitherto not gained a 
permanent foothold elsewhere; it is limited in its con- 
tinuance by frost, which seems absolutely fatal to the 
micro-organism, though the infecting insect survives the 
winter. 

The third of these diseases, trypanosomiasis (sleeping 
sickness), caused by the protozoon Trypanosoma, and 
transmitted by the dipterous insect Glossina, need not 
be considered by us. The infecting insect occurs only 
in Africa, and the chance of this disease being brought 
to our shores is at present remote. 

Hay-Fever. Hay-fever, as designated in this country, 

1 Op. cit. and Supplement to Public Health Report, Nov. 13, 1903. 



48 THE CLIMATIC TREATMENT OF CHILDREN 

is a misnomer; true hay-fever, caused by the pollen- 
toxin of grasses, occurs in May and June, and is called, 
in this country, rose-fever. Our so-called hay-fever is 
properly ragweed-fever, prevails in late summer and 
early fall, and is produced by the pollen-toxin of the 
ragweed (various species of Ambrosia) and possibly of 
various other composite (Solidago, etc.). This etiology 
has been brilliantly and successfully demonstrated by 
Dunbar, 1 who, on the basis of the modern theory of 
immunity,' has also managed to evolve an antitoxic 
treatment for this affection. Britton and Brown 2 give 
the following distribution for the genus Ambrosia: Nova 
Scotia to Florida, west to British Columbia and Mexico. 
The time of pollination is June southward, and later 
northward, until October. In and near New York City 
the plants begin to bloom about the 20th of August, 
continuing more or less until the first killing frost toward 
the middle of October. It would seem that the plant 
is poorly developed and secretes little toxin along the 
northern and higher limits of its range, for the charac- 
teristic fever does not pass beyond the July isothermal 
of 66 degrees. This circumstance will be utilized in our 
discussion on treatment, to be taken up in a later chapter. 
As with all diseases caused by jboxins, predisposition 
plays an important role in hay-fever; country people 
seem to possess an immunity, probably antitoxic, where- 
as the residents of towns are liable to this affection nearly 
in proportion to the respective sizes of the cities. At 
first thought, it might be supposed that city life should 
confer almost complete protection against a toxin, that 

1 Berliner klinische Wochenschrift, 1903. 

2 Illustrated Flora of the U. S. and Canada, 1897. 




isothermals for july 
Not Reduced to Sea 

Level 

Eastern United States 

and Canada 



CHAPTER II 



THE CLIMATOLOGY. OF TEMPERATE NORTH AMERICA 



Excellent monographs, well adapted for reference, 
describe the climates of most European countries, as 
well as of remote regions like Japan, India, and the 
Argentine Republic; there is no recent work of this 
kind dealing with the climate of our continent in a 
comprehensive manner, supplying the physician with 
statistical material in a readily accessible form. As a 
substitute, therefore, I have found it necessary to insert 
a somewhat lengthy chapter on this subject here, for it 
seems futile to refer to climates for which accurate data 
are not readily obtainable. 

We must introduce this subject with a brief review of 
the general topography of North America. This con- 
tinent presents a compact mass of land, extending from 
the thirtieth to the seventieth parallel, widening toward 
the north, rapidly tapering southward into the relatively 
narrow Mexican Plateau. In winter the continent is 
practically continued to the pole by the freezing of the 
Arctic Ocean; to the southeast we encounter the per- 
ennial influence of the warm-water reservoir of the Gulf 
of Mexico. We might therefore expect a continental 
climate throughout the year in the center, and during 
the winter in the north otherwise oceanic conditions; 
the last, however, for reasons to be given below, occur 
only on tJie outermost edge of the mainland, and to a 

50 



CLIMATOLOGY OF NORTH AMERICA 51 

limited extent; in general, the North American climate 
is continental to or near to the very coasts. 

The main topographical feature is the immense barrier 
of the Cordilleran Mountain system, traversing the entire 
length of the continent, closely hugging the Pacific coast, 
and separating very sharply a narrow strip of land 
along that shore from the broad and uniform Atlantic 
slope. From British Columbia into Mexico, this moun- 
tain system broadens out into a great plateau, with a 
maximum breadth of a thousand miles on the fortieth 
parallel. This plateau, while it has, in a measure, a 
climate of its own, is yet more western than eastern in 
its general features, and the continental divide, as well 
for climate as for surface drainage, with a crest ranging 
from five to eight thousand feet in height, is near its 
eastern edge. The Laurentian and Appalachian (Alle- 
ghany) Mountains require but few words, for their cli- 
matic importance is slight and purely local; they "are 
too low to deflect the air-currents materially. The Ozark 
Mountains in the south central region are so insignificant 
that they may be altogether disregarded. 

The great bodies of water that surround and indent 
the continent, or are imbedded in it, play a very sub- 
ordinate part. Only .on the Pacific slope does the ocean 
dominate the climate, and here the coast ranges limit 
its influence to a very narrow strip of territory. The 
Atlantic Ocean affects materially only the summer cli- 
mate on the east coast; in winter the prevailing west 
winds greatly restrict its influence, and between the 37th 
and 44th parallels this is largely true also in summer. 
The Gulf of Mexico is more important, as it supplies 
most of the ample rainfall of the southeastern quarter 



52 THE CLIMATIC TREATMENT OF CHILDREN 

of the continent; it also contributes to the remarkable 
eccentricities of the temperature in this region, unknown 
in such low latitudes elsewhere. The importance of 
Hudson Bay may be considerable, but interests us only 
very slightly; the Great Lakes act only on their immedi- 
ate shores, but their leeward banks are materially 
affected by their tempering influence, as we shall see 
later. 

The Atmospheric Pressure and Prevailing Winds. The 
average atmospheric pressure is necessarily in some rela- 
tion to the general topography, and the direction of the 
lower air currents depends chiefly on the barometric 
conditions. In giving a concise description of these two 
climatic elements, the lack of reliable data limits us to 
that portion of the continent which lies between the 
fifty-third parallel and the southern boundary of the 
United States; fortunately, these are the regions that 
interest us most. We shall* take up the pressure and 
prevailing winds according to the seasons. 

In winter the dominant feature is the great area of 
high pressure covering nearly the whole United States, 
with local maxima of 30.17 inches in southern Idaho, 
and 30.15 in the southern Alleghanies. In the northeast 
we encounter the great North Atlantic depression, with 
29.84 inches over eastern Newfoundland; a similar figure 
obtains on the Alaskan coast; between them runs a ridge 
of higher pressure, gradually fading away toward the 
general low pressure of the Arctic regions. The pressure 
is also relatively low over the southwestern plateau, 
30.00 inches at El Paso, and is depressed to the same 
figure just north of the Great Lakes. 

The prevailing winds are northwest, with only the 






CLIMATOLOGY OF NORTH AMERICA 53 

following exceptions : In the southerly parts of the Lake 
Region, ancl.as far as the Ohio River, they are southwest, 
blowing toward the Lake depression. They are north- 
east in extreme southern Florida and Texas (trade 
winds), also locally in the southwest, blowing toward the 
Mexican depression. The direction in the North Pacific 
states is generally southeast, on account of the Alaskan 
"low." In all, only six states show a predominance of 
easterly winds at any stations; elsewhere they blow 
uniformly from some point between north-northwest and 
west-southwest. 

Both the differences of pressure and the prevalence of 
westerly winds are less marked than might be expected 
over so vast a continental area, not even remotely 
approaching the conditions obtaining in Asia, where the 
pressure in January exceeds 30.60 inches near Lake 
Baikal, and east winds are a rarity in Manchuria arid 
North China. It is true that east winds predominate 
at but few American stations, but they are quite com- 
mon everywhere, save in exceptionally severe seasons. 
This low average barometric gradient and the resulting 
variability of the air currents are due to the fact that 
the center of this continent presents the most frequented 
storm track in the northern hemisphere.. Every few 
days a storm starts from either the North Pacific or 
Mexican depression, to cross the United States and 
southern Canada at often more than railway speed, so 
that the high-pressure areas, that form chiefly in the upper 
Missouri valle}^ rarely endure for a week at a time. 

With the' advance of spring the distribution of 
pressure becomes more uniform. A feebly developed 
area of high pressure extends from Hudson Bay to the 



54 THE CLIMATIC TREATMENT OF CHILDREN 

southeastern states, nowhere exceeding 30.03 inches, and 
a second "high," of 30.08 inches, lies off the North Cali- 
fornia coast. The southwestern depression has become 
quite extensive, with a minimum of 29.82 inches in New 
Mexico, and there seems to be a similar less marked area 
in British Columbia. The North Atlantic depression has 
become relatively feeble, 29.92 inches over the Gulf of 
St. Lawrence. 

The wind direction is now very irregular; generally 
west to northwest east of the eastern belt of high pres- 
sure, east to southeast on its west side ; generally westerly 
over the western half of the continent, north to north- 
east in the greater part of the Lake Region. The pressure 
is apparently a little lower from about Chicago to 
Buffalo than either to the north or south; hence the 
peculiarity last mentioned. 

As the maximum pressure on the Pacific Coast is off 
northern California, the winds are northwest southward, 
and southwest in Washington, Oregon, and Idaho. In 
southern Florida the northeast trade-winds still prevail. 

In summer the main feature is a belt of low pressure 
in the western mountain region, with a deep minimum 
of 29.75 inches in Arizona. The high areas off California 
and in the South Atlantic states maintain almost the 
same intensity as in spring, but the high pressure north 
of Lake Erie has totally disappeared. 

Southwest winds now prevail east of the Mississippi 
River, southeast winds continue west thereof; the only 
important exception is that the trade winds, deflected a 
little to the southward, now extend to northern Florida. 
On the Pacific coast the winds are everywhere nearly due 
west, but with the tendency north or south, that we 



CLIMATOLOGY OF NORTH AMERICA 55 

noted for the spring months. The predominance of 
these air currents is much more marked in summer than 
in spring, especially in California, where a persistent 
downward pressure gradient of 0.15 inch exists from 
the coast to the interior; east winds are therefore a 
great rarity in that section in the summer months. 

The most striking feature of autumn is the West 
Indian depression, 29.90 inches at Havana during Sep- 
tember and October, the hurricane season; the south- 
western depression fills up rapidly, and the minimum in 
Arizona is 29.88 inches. Over Canada the pressure falls 
steadily northward, ranging from 29.94 to 29.96 inches 
along the fifty-third parallel. There are two high areas, 
one over the southern Alleghanies, of 30.10, the other 
in eastern Oregon, 30.08 inches. These gradually be- 
come fused together in November to form the great 
continental "high" of the winter months. 

The autumn winds are northwest in the northeastern 
districts, and southwest from Tennessee to northern 
Ontario. West of the Mississippi they continue south- 
east, and from the continental divide westward the con- 
ditions are similar to those of spring. In the southeast 
the winds are northeasterly from the Virginia capes to 
Alabama, as if the trade winds had advanced northward 
to the 37th parallel; this is perhaps not strictly accu- 
rate, as this phenomenon does not cover the whole north 
temperate Atlantic in these latitudes, but seems to be 
peculiar to the portions near the American coast. 

The West Indian hurricanes are not very numerous, 
only two or three coming within our field of observation 
in the course of a season; the very destructive ones 
occur about once in three years. The continental storms 



56 THE CLIMATIC TREATMENT OF CHILDREN 

are commonest from November to March. Thus the 
months from April to July are relatively free from 
severe disturbances of the atmosphere, many weeks often 
elapsing without a well-developed storm. As the West 
Indian hurricanes affect only the southeast quadrant of 
our continent, the remaining portions are relatively un- 
disturbed from August to October as well; in fact, these 
months are the quietest of all in the central and western 
sections, save that October occasionally is rather un- 
settled in the farthest north. 

It might be worth our while to devote a page or two 
to the elements that make up the weather in the United 
States and Canada; a clear exposition of their relations, 
which are quite simple, will make the entire subject so 
plain, as to render further explanation unnecessary. 

The characteristic feature of North American weather, 
especially from November until the vernal equinox, is 
the frequent, rapid, and almost rhythmical succession of 
waves of high and low pressure; most of the latter cross 
the continent from ocean to ocean, but a very great 
number originate in the north Mexican depression. The 
well defined "lows" outnumber the " highs," tending to 
fuse together; their average speed is 32 miles per hour 
in the winter months, but occasionally a rate of 60 miles 
is maintained or exceeded for a day or two at a time; 
the feebler depressions of the warmer months travel far 
more slowly. The rate mentioned is nearly double that 
of the storms of western Europe, and we consequently 
expect the American climate to be about twice as change- 
able. The main storm paths are as follows : the first 
travels from, the North Pacific depression to the Lake 



CLIMATOLOGY OF NORTH AMERICA 57 

Region and Newfoundland, the second from northern 
Mexico to the Lake Region and Newfoundland, the 
third, less frequent, from northern Mexico or some other 
part of the tropics or subtropics, to and along the Gulf 
Stream, also to Newfoundland. 

Next to the storms, the "cold waves" accompanying 
the winter " highs " claim our attention. These regularly 
originate in the Canadian Northwest and usually travel 
more or less to the southeast, according to the path fol- 
lowed by the preceding "low." After a storm of the 
first type, the course of the cold wave is but little south 
of east, and only the northern states and Canada are 
much affected; after a storm of the second type, the 
cold wave travels down the slope toward Mexico, and* is 
felt most severely in the Rocky Mountains and to the 
east thereof; after one of the third type, the "high" 
moves exactly southeast, with severe frosts in the lower 
Mississippi Valley and on the South Atlantic Coast. 

As the greatest "highs" are apt to follow the deepest 
"lows," it is not rare in winter to observe a fall of 40 
degrees or more in twenty-four hours. The reverse is 
less common, and equally sudden rises are infrequent, 
save on the eastern slope of the northern Rocky Moun- 
tains, where warm "Chinook" winds are apt to accom- 
pany a storm of the first type. 

The West Indian hurricanes, nearly all of which occur 
between August and October, generally follow the third 
path; owing to the season, they are not succeeded by 
cold waves. The great Galveston hurricane, however, 
after reaching the Texas Coast, followed path number 
two; this happens very exceptionally. 

From the above review of the storm tracks and cold 



58 THE CLIMATIC TREATMENT OF CHILDREN 

waves, we can readily understand why the climate east 
of the* continental divide is so much more variable than 
that to the westward; we shall presently have occasion 
to demonstrate this mathematically. We are also not 
astonished to learn that the differences in temperature, 
according to latitude, are greater in the eastern half of 
our continent than in any other part of the globe. The" 
irregularity of our eastern winter climate is rivaled only 
in Western Siberia, which lies much farther north. 

Before quitting this subject entirely, we may add a 
few remarks on certain local winds, varying from the 
above generalizations. Warm descending winds are a 
feature of the great western river valleys. Being dynamic- 
ally warmed, they raise the. average temperature rather 
abnormally in the lower reaches; not so much* in the Rio 
Grande, Gila and Colorado River Valleys, where they 
are more or less northerly, as along the Snake and middle 
Columbia Rivers, where they blow from the south; in 
all these sections, the stations on the plateaus appear 
relatively cold, those low down abnormally warm. In 
the Pacific states we have some interesting examples of 
deflected winds. The almost unceasing west winds that 
enter at the Golden Gate in summer branch off in the 
interior, northward in the Sacramento Valley, southward 
along the San Joaquin. The result is that Red Bluff has 
almost exactly the same July temperature as Fresno, 
though it lies two hundred miles farther north. . In win- 
ter the west winds are less continuous, but the same 
effect is noted, and the January temperatures are like- 
wise almost identical at the two stations named; we 
must note, however, that the wind shelter of the Sierra 
Nevada, north of Red Bluff, is a factor that is at least 



CLIMATOLOGY OF NORTH AMERICA 59 

in part responsible for this curious anomaly. The river 
valleys of Oregon show the same deflection, with a 
similar effect on the temperature; thus Roseburg has 
northerly winds in summer, because of the direction of 
■ the Umpqua River, and is sixteen degrees cooler in sum- 
mer than Red Bluff, which lies just two hundred miles 
to the south. If we draw Portland into the comparison, 
we see that Roseburg is about four degrees cooler in 
July than it should be, Red Bluff about as much warmer. 

For the causation of "foehn" winds, blowing from the 
mountains into the valleys, chiefly in the prevailing wind 
direction, the reader is referred to works on meteorology. 
Under the local name of " Chinook" winds^ they are a 
characteristic feature in the Rocky Mountains, most 
marked in Alberta and Montana, but still conspicuous 
in eastern Wyoming and Colorado. Their chief effect 
is a decided relative warming of the eastern slope, most 
marked in winter, but also noticeable at the other seasons. 

Piercingly cold gales of the " mistral " type are common 
on the Atlantic and Gulf Coasts, and on the western 
shores of the Great Lakes. On the coasts they occur 
everywhere from Labrador to Vera Cruz, where they 
are known as northers; they are always most violent 
and continuous when the land immediately behind the 
coast is hilly or mountainous, and therefore are especially 
trying north of New Jersey. The vicinity of New York, 
where the Alleghanies approach nearest to the coast, is 
especially subject to these winds, which are at their 
worst in February and March, but may occur as early 
as November or as late as April. 

In summer certain points on the lakes are subject to 
lake breezes during the day, and land breezes at night; 



60 



THE CLIMATIC TREATMENT OF CHILDREN 



this type of winds also prevails on the Atlantic and Gulf 
Coasts from April or May to September. 

The mean wind velocity on our continent is as follows: 





Miles Per Hour. 




Summer. 


Winter. 




8-16- 

4- 7 
8-10 

5- 8 
13-15 

6-10 
5- 7 
6-22 


16-24 




7-10 




12-14 


Ohio and Mississippi Valleys ,...*.. 

The Great Plains 


8-12 
11-17 




6-10 


Pacific States, Interior 


5- 7 
6-12 







These figures are, of course/ mere averages, and only 
specially exposed stations give the higher rates. Ob- 
serve the high figures on the prairies and the coasts, but 
especially the high summer records on the Pacific Coast, 
whereas the winter months lead on the Atlantic side. 
We may state at once that an average exceeding ten or 
twelve miles an hour is apt to be unpleasantly high; 
such figures as 22 miles on the North California Coast, 
and 24 miles at Block Island, in summer and winter 
respectively, render these localities quite unfit for the 
purposes of health or recuperation, at the seasons 
named, for it requires a frequent recurrence of violent 
gales to produce so great an average. 



After the above outline of the conditions that deter- 
mine the general character of the North American cli- 
mate, we may go on to a comparatively minute chronicle 
of details. I have taken special pains to give as full 
tables as possible, including all official records that may 
serve as standards, and as many of the popular resorts 
as possible; doubtful data have, however, been rigidly 



CLIMATOLOGY OF NORTH AMERICA 



61 



excluded, unless it was possible to modify them to 
something like accuracy. It is to be regretted that 
many current reports are based upon a single exceptional 
season, and that these anomalous returns have been 
exploited for commercial purposes; the usual statement, 
for instance, that Lakewood, N. J., is ten degrees warmer 
than New York City in - winter, is a typical and flagrant 
example. 

TEMPERATURE 

Before discussing the subject of temperature in detail, 
we may, with profit, devote a page or two to the study 
of the true . value of our records. Those here given 
either include a complete series of observations for thirty 
years (1871-1900), or they are reduced to this standard 
by comparison, for several years, with the nearest sta- 
tion of long record. Hann has shown that such adapted 
records are quite trustworthy in the case of near-by 
stations. In the western United States, however, the 
distance may be two hundred miles or more between the 
standard station and the one of short record ; these may 
therefore occasionally present an error of a degree or 
two in the winter months. 

In accepting a thirty-year average, we must bear in 
mind that even this may not be absolutely true; cal- 
culation shows that the probable error, plus or minus, is : 



New Jersey 
Illinois 
Louisiana . , 
Manitoba . . 
Colorado . . 
California . , 



Winter, 


Summer, 


Degrees 


Degrees 


0.6 


0.3 


0.9 


0.4 


0.6 


• 0.2 


1.1 


0.4 


0.7 


0.4 


0.4 


0.2 



Year, 
Degrees 



0.16 
0.22 
0.13 
0.30 
0.16 
0.13 



62 



THE CLIMATIC TREATMENT OF CHILDREN 



The absurdity of giving decimals for the winter months 
is obvious, and there is a J chance of error even in 
summer; in the tables, therefore, they are quoted for 
the annual means only. 

A circumstance that interferes seriously with thermo- 
metric comparisons, and for which we must make due 
allowance, is the higher temperature in large cities, as 
compared with suburban or rural districts. The fol- 
lowing examples are illustrative: 





Jan. 


July 


Year 


Minimum. 


Daily 




Average 


Absolute 


Range 


Baltimore (city) 

Washington (suburban) 

New York City 

New Haven (suburban) . 


34,1 
33.2 

30.8 
27.5 


77.3 

76.8 

73.8 
71.8 


55.3 
54.7 

52.0 
49.4 


+6 
+3 

+2 
-3 


- 7 
-15 

- 6 
-14 


15.8 
18.0 

14.0 
16.2 



According to the difference in latitude, Washington 
should be 0.8 degree warmer than Baltimore, and New 
Haven only 1.2 cooler than New York; the larger cities 
are therefore 1.4 degree too warm, their minima average 
four degrees too high, the daily range is reduced 2.2. 
In the tables that follow, wherever this discrepancy is 
suspected, city temperatures are marked (C) ; to obtain 
suburban temperatures, about 1.5 degrees should be 
subtracted. 

Subarctic North America. Certain portions of our 
continent, although well to the south of the Arctic 
Circle, have nevertheless a climate that must be called 
subarctic, in view of the absence of a true summer. 
This section includes southern Greenland and Labrador, 
for which the following data are illustrative : 



CLIMATOLOGY OF NORTH AMERICA 



63 





0> 

•V 

"-J3 
o3 


a; 

T3 

3 

"Si 
a 
o 

h3 


>> 

u 

03 

3 
£ 
03 

►"5 


>> 

03 

3 
(- 

V 

fa 


o 

u 
03 

9 


ft 

< 


>> 
03 


c 

3 
i-a 


3 


gg 
3 
5t 

3 
< 


u 

33 

S 
& 
ft 

QQ 


0/ 

c 
e 

C 


o 

1 



Z 


0/ 
-C 

e 

P 


03 




64.2 
56.6 


51.7 
61.7 


14 
-6 


14 
-5 


17 
+7 


26 
20 


35 

32 


40 
41 


44 
47 


43 
49 


37 
41 


30 
31 


24 
18 


19 
6 


28 6 




23 4 







The winter in southern Greenland resembles that of 
Maine, but the summer is no warmer than the Maine 
October; it is somewhat warmer than the above figures 
back in the fjords, where the maximum temperature has 
reached 74 degrees. The winter is sometimes quite 
arctic;' in other years rather mild, with frequent thaws. 
The mean monthly range is about 45 degrees in winter 
and only 25 in summer; temperatures under -20 are as 
rare as a summer-like warmth. 

Labrador lies ten degrees to the south of Greenland, 
but the climate is decidedly worse, being but little 
warmer in summer, and very much more severe in winter. 
The temperature is the lowest known for the latitude, 
which corresponds to that 'of the British Isles; Nain is 
43 degrees colder than Aberdeen in January, and 11 in 
July. 

The influence of the ice drift on the climate of the 
Labrador coast is shown by the retardation of the sum- 
mer warmth, August being warmer than July. The 
ordinary .annual range of temperature at Nain is from 
77 to —36 degrees; exceptionally 80 and —45 have been 
observed. Both winter and summer are very erratic, 
as land and sea breezes alternate with great frequency, 
particularly at the latter season. 

Little is known of the climate of interior Labrador, 
but the more luxuriant vegetation points to a warmer 



64 



THE CLIMATIC TREATMENT OF CHILDREN 



summer, averaging about 55 degrees in July. The aver- 
age for January is probably not much lower than on the 
coast, say about 10 below zero. 

The Maritime Provinces and Newfoundland. In and 
about the Gulf of St. Lawrence, the climate is interme- 
diate between those of Labrador and our northeastern 
states. The summer remains remarkably cool for the 
latitude, and the winter is still quite raw,- so that the 
temperature as a whole resembles that of Sweden, ten 
to fifteen degrees farther north. The following table 
will illustrate this more fully: 



St. John's, N. F 

Charlottetown . 

Sydney 

Halifax 

Yarmouth 

St. John, N. B. . 
Chatham) 

Father Point . •. 



47.6 
46.2 

46.2 

44.6 
43.8 

45.3 
47.0 



52.7 

63.3 

60.2 
63.6 
66.0 

66.1 
65.5 

68.3 



35 



43 



35,46 



40.4 

40.8 

41.1 
42.7 
43.0 

41.1 
38.4 

34.6 



The extremes and daily range in this district are as 
follows : 





Average 


Absolute 


Daily Range 




Max. 


Min. 


Max. 


Min. 


January 


July 


St. John's .... 


84 


- 6 


92 


-21 


17—29 


51—67 


Sydney 


85 


-15 


90 


-25 


13—27 


53—71 


Halifax '. 


89 


- 8 


93 


-17 


15—30 


54—72 


Yarmouth . . . 


78 


+ 1 


83 


- 2 


21—34 


52—67 


Chatham .... 


92 


-27 


98 


-33 


1—19 


54—76 


Father Point . 


• 81 


-26 


87 


-31 


0—16 


49—67 



We see that steady freezing weather is the rule in 
winter, and that the summer days are fairly warm in the 



CLIMATOLOGY OF NORTH AMERICA 



65 



interior of New Brunswick, but very cool at exposed 
coastal stations. Among the hills of New Brunswick 
the temperature may rise to 100 and fall below - 40. 

The St. Lawrence and Ottawa Valleys. In this district, 
forming a sort of wedge between the maritime provinces 
and the Lake Region, we find an extreme continental 
climate. 



Chicoutimi 
Quebec . . . 
Montreal . 
Ottawa . . . 
Rockliffe . 



48.4 
46.8 
45.5 
45.4 
46.2 



71.1 
71.2 
73.6 
75.8 
77.9 



a 



150 
100 
90 
330 
560 



65 



53 40 24 9 35 . 2 
56 43 29 16 38 



58 4531 
67;57|43 29 
64 55142 28 



18i41.6 
1640.4 
14138.0 



* The extremes and daily range are as 


'ollows : 






Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


January 


July 


Quebec 

Montreal 

Ottawa 

Rockliffe 


89 
89 
92 
93 


-25 
-21 
-29 
-38 


96 

94 

98 

100 


-32 
-26 
-33 
-46 


3—17 

7—20 

2—19 

-5—18 


57—75 
61—78 
59—80 
53—80 



In the Ottawa Valley, - 50 degrees have been reached 
on * exceptional occasions. At the July isothermal 
of 68 degrees we encounter the vanguard of the flora of 
the middle temperate zone, as- represented by the hickory 
and grape-vine; elsewhere the vegetation is of the type 
commonly called Canadian. The intense cold of the 
winter at Montreal and Ottawa sets no limit to the 
growth of the more southerly forms, for their only 
requirement is a sufficient warmth in midsummer. 

The North Atlantic States. From Maine to Virginia 
there prevails a remarkable climatic uniformity, the 



66 



THE CLIMATIC TREATMENT OF CHILDREN 



differences due to latitude, elevation, and proximity to 
the ocean can be reckoned mathematically to within a 
fraction of a degree; this makes it uncommonly easy to 
pick out the "city temperatures" in this district, and 
also enables us to estimate pretty closely the tempera- 
ture for a station, for which no actual observations are 
recorded. The table that follows is not too long when 
we consider that this region includes very many of our 
largest cities and most popular resorts. 

New England 



Kineo, Me 

Bethlehem; N. H 
Northfield, Vt. .. 

Eastport 

Bar Harbor. 

Portland (C) 

Boston (C) , 

New Haven 



45.7 
44.2 
44.2 

44.9 
44.3 
43.6 
42.4 
41.3 



69.7 
71.7 
72.7 

67:0 
68.2 
70.2 
71.1 
72.9 



1000 

1480 

880 

80 

50 

100 

120 

110 



37.3 
39.2 
41.2 

41.5 
43. P 
45.7 
48.6 
49.4 



Islands 



Nantucket 

Block Island 

Southampton, L. I. 



41.3 
41.2 
40.9 



70.1 20 31 
71.5 30 31 
72.4 30 31 



52 61 

53 62 
56 65 



70 



48.8 
49.1 
50.1 



New York 



Albany (C) . . . 
Poughkeepsie 
New York (C) 

Saranac Lake 
Cooperstown . 
Liberty 



42.7 
41.7 
40.7 

44.3 
42.7 
41.8 



73.8 
74.0 
74.0 

74.1 
75.0 

74.8 



100 

120 

90 

1550 
1300 
1470 



69 



48.2 
48.6 
52.0 

39.1 
43.5 
44.7 



New Jersey 



Lakewood . . . 
Atlantic City 



40.1 
39.4 



74.2 
74.4 



100 
50 



57 



54 43 
56145 



51.2 
51.9 



CLIMATOLOGY OF NORTH AMERICA 67 

Eastern Pennsylvania 



Scranton 

Harrisburg .... 
Philadelphia (C) 



41.5 
40.3 
40.0 



75.7 
76.9 

75.2 



800 

370 

90 



4557 66 
48 60 69 
5062!72 



70 68 
73 71 

76174 



-Z > 
o o 



50 39 
53 42 
56 45 



29 47.6 
33 50.8 
36 53.5 



Maryland and Virginia 



Baltimore (C). 
Washington . 
Richmond (C) 
Norfolk 



Lynchburg 
Wytheville 



39.3 
38.9 
37.5 
36.8 



37.4 
36.9 



76.6 
77.0 

77.5 
76.3 

79.2 
81.1 



9034 3642 
11033 35 42 
140J38 40 46 

90l40 43147 

680'37^40|46 
2290 33 36 42 



53 64 
53 64 

5767 
56 66 

56! 66 
5261 



73 77| 75 '68 57 
73;7775i68 56 
75 79 77 70 60 
75 79 7771 61 



74 78 76 
697270 



68 57 
64 54 



55.3 
54.7 
58.4 
59.0 

56.9 

52.7 



The following table gives the extremes and daily 
range at a number of stations : 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


January 


July 


Northfield . . . 
Eastport .... 
Portland .... 

Boston 

Nantucket. . . 

Albany 

New York. . . 
Atlantic City 
Philadelphia . 

Washington. . 

Norfolk 

Lynchburg . . 


91 
85 
93 
•96 
84 

95 
95 
92 

97 

98. 

98 

98 


-25 
-13 

- 9 

- 5 

2 

-10 
2 
3 
3 

2. 

13 
5 


98 
93 
97 - ■ 

102 
89 

100 

100 

96 

103 

104 
102 
102 


-32 
-21 
-17 
-13 

- 4 

-24 

- 6 

- 7 

- 6 

-15 
3 

- 6 


7—25 
14—26 
15—29 
20—34 
26—37 

16—31 
25—38 
27—40 
25—40 

25—42 
32—48 
28—46 


54—78 
53—68 
60—76 
63—80 
62—73 

63—83 
67—82 
66—78 

68—85 

68—87 
70—88 
67—89 



On Nantucket and Block Island the climate, is oceanic, 
in the interior of Virginia quite continental; the seasons 
are three weeks earlier in the latter. Lynchburg is 14 
degrees warmer than Nantucket in May, whereas there 
is practically no difference in November. 

The daily variability of the temperature is as follows : 



68 



THE CLIMATIC TREATMENT OF CHILDREN 





Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 


Year, 
Degrees 




6.0 
8.2 


5.2 

5.7 


" 3.4 
4.2 


4.6 
5.7 


48 


Interior New England 


6.0 



The latter figures are as high as any on the continent. 

Inversion of temperature is not sufficiently common 
in the Alleghanies to affect the averages very materially, 
because the cold waves rarely halt in this section for 
even a day or two at a time. It occurs only when the 
actual crest of a high-pressure area overlies the moun- 
tain belt on a quiet night, and is usually aided on such 
occasions by a snow covering, which favors radiation. 
Altogether, the winter uniformly grows colder with in- 
creased elevation. The fall of temperature in ascend- 
ing may be studied conveniently by comparing the 
summit of Mt. Washington with Bethlehem, not far 
from its base : 





Elev., 
Feet 


Jan., 
Degrees 


Apr., 
Degrees 


July, 
Degrees 


Oct., 
Degrees 


Year, 
Degrees 




6290 
1480 


5 
14 


21 
, 36 


47 
64 


29 ■ 
42 


► 25.5 




39.2 






Difference 

Difference per 


4810 
1000 


9 
1.9 


15 
3.1 


17 
3.5 


13 

2.7 


13.7 

2.8 



This rate prevails generally throughout the eastern 
mountains, and may be used to calculate the tempera-, 
ture for-all elevated situations in this half of the continent. 
In northern New York and New England the monthly 
range of temperature averages 70 degrees in winter, and 
50 in summer; in the interior of Virginia these figures 
are reduced to about 60 and 40 respectively, so that the 
winter months, at least, are very variable throughout. 



CLIMATOLOGY OF NORTH AMERICA 69 

On the Middle Atlantic Coast the corresponding figures 
are only about 50 and 35. 

The enormous difference in temperature between 
northern Maine and southeastern Virginia, only 800 
miles apart, is plainly shown by the vegetation, which 
ranges from arctic types on the mountain summits of 
New Hampshire, through a Canadian flora in the far- 
northern valleys, to the five oaks and red bay trees 
about Norfolk. A trip from Moscow to Madrid affords 
•a smaller climatic change than one from the lakes of 
Maine to Cape Henry. Thus, despite the great annual 
range at the individual stations, cool summers and mild 
winters are within quite a short distance of each other. 

The Hudson River, at Albany, is regularly frozen from 
December 15th to March 20th, but exceptionally severe 
seasons may add two weeks or more at either end. Only 
once in more than a century has it remained open; this 
occurred in the abnormally mild winter of 1889-90. The 
freezing of the Hudson is accelerated somewhat by its 
sluggish current, and occurs with the first fall in tem- 
perature to near the zero mark. 

The Lake Region. The climate of the Lake Region is 
far less uniform than that just described. Considerable 
subdivision is necessary properly to group the very 
diverse and apparently somewhat irregularly distributed 
variations in this section. The key to the problem lies 
almost entirely in the respective situation on the wind- 
ward or leeward sides of the different lakes, for, in win- 
ter at least, the opposite shores have comparatively 
little in common, owing to the prevailing west winds at 
that season; we may therefore group the stations 
accordingly. 



70 



THE CLIMATIC TREATMENT OF CHILDREN 



Lake Ontario 



Kingston .... 
Toronto 

Oswego 

Rochester (C) 



44.2 
43.6 



43.5 
43.2 



76.5 
79.4 



76.5 

77.7 



280 
290 



300 
520 



70 



66 



42.9 
44.0 



46.5 
46.8 



Lake Erie 



Port Stanley 

Buffalo (C), 
Erie (C) . . . . 
Cleveland . . 
Toledo (C) . 



42.7 


81.2 


620 


22 


22 


28 


41 


53 


63 


68 


66 


59 


48 


36 


27 


42.9 


78.9 


640 


25 


25 


30 


42 


55 


65 


70 


69 


62 


51 


39 


30 


42.1 


80.1 


620 


27 


28 


33 


45 


57 


67 


71 


70 


64 


53 


41 


32 


41 .5 


81 .7 


630 


27 


28 


34 


46 


58 


6X 


72 


70 


64 


53 


41 


31 


41.7 


83.5 


630 


26 


28 


35 


48 


59 


69 


73 


71 


64 


52 


40 


30 



44.4 

47.0 
49.0 
49.3 
49.6 



Southern Michigan 



Detroit (C) 



42.3 



83.0 



630 



25 



27 



33 



46I58I68 

I I 



72 



70 



63 



51 39 



29 



48.4 



Lake Huron 



Saugeen .... 
Parry Sound 

Port Huron . 
Alpena 



44.5 
45.2 



42.9 
45.1 



81.4 
80.0 



82.5 
83.5 



630 
610 



610 
610 



65 



65 



42.3 
40.1 



45.3 
41.3 



Lake Michigan 



Grand Haven 
Mackinaw . . . 

Chicago (C) . . 
Milwaukee . . 
Green Bay . . 



43.1 

45.8 

41.9 
43.0 
44.5 



86.2 630 
84.4: 610 

87.7 620 
87.9 620 
87.9 620 



54164 
48|59 

5767 

54 63 

55 65 



46.3 
41.3 

48.6 
45.2 
42.7 



Lake Superior 



Marquette. . 
Duluth 

White River 
Port Arthur 



46.6 


87.4 


640 16 


17 


24 


38 


49 


59 


65 


64 


57 


45 


32 


23 


46.8 


92.1 


640 


11 


15 


24 


38 


48 


58 


66 


65 


56 


45 


30 


18 


48.4 


85 . 3 


1250 


-1 


2 


12 


31 


45 


56 


61 


59 


51 


37 


20 


7 


48.4 


89.2 


640 


3 


6 


16 


33 


45 


56 


62 


60 


53 


40 


24 


12 



40.8 
39.5 



31.7 
34.2 



CLIMATOLOGY OF NORTH AMERICA 



71 



The distribution of temperature is thus far more 
irregular in the Lake Region than on the Atlantic Coast; 
this is sufficiently evident from the above table, but is 
illustrated even better in the following list giving the 
extremes and daily range : 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


January 


July 


Kingston .... 

Toroilto 

Rochester .... 

Port Stanley. 

Buffalo 

Cleveland. . . . 

Saugeen 

Parry Sound. 
Port Huron . . 

Alpena 

Detroit 

Grand Haven 

Chicago 

Milwaukee . . . 
Green Bay. . . 

Marquette . . . 

Duluth 

White River . 
Port Arthur . . 


88 
91 
94 

89 
89 
93 

89 
89 
94 
92 
94 

88 
95 
94 
94 

94 
92 

88 
89 


-20 
-13 

- 5 

-14 

- 5 

- 6 

-14 
-31 
-10 
-16 

- 7 

- 6 
-13 
-17 
-24 

-17 
-29 
-52 
-34 


93 
98 
99 

94 
95 
99 

94 
95 
99 
98 
101 

94 
103 
100 

99 

108 
99 
94 
95 


-32 
-23 
-14 

-27 
-14 
-17 

-30 
-38 
-25 
-27 
-24 

-25 
-23 
-25 
-36 

-27 
-41 
-58 
-40 


9—25 

14—29 
17—31 

15—30 
19—31 
21—34 

12—28 
5—24 
15—29 
12—25 
19—32 

18—31 

18—31 

14—27 

7—22 

10—22 

4—19 

- 14—12 

- 7—13 


60—76 
58—78 
61—79 

59—78 
63—78 
64—80 

56—74 
56—77 
60—78 

57—74 
63—81 

60—78 
65—80 
61—78 
60—80 

57—74 
59—74 
48—75 
52—72 



The daily variability in the Lake Region is less in 
winter, but greater in summer, than in the Atlantic 
States; the lakes never freeze over, and therefore temper 
the former season; in summer, the alternation of land 
and lake breezes causes frequent and rapid fluctuations. 
The averages are : 



Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 


Year, 
Degrees 


6.8 


6.0 


4/4 


5.2 


5.6 



We can best appreciate the influence of these great 
bodies of fresh water, by following a parallel of latitude, 



72 



THE CLIMATIC TREATMENT OF CHILDREN 



for example, the 43d, from west to east. In the fol- 
lowing table all temperatures have been reduced to a 
600-foot level, and all "city temperatures" corrected: 



. 


Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 




20 
24 

22 
24 


43 
44 
42 
41 


69 
69 
69 

68 


49 
50 
49 
50 


45.2 
46.4 
45.3 
45.7 


94 
89 
94 
90 


-17 


Grand Haven 

Port Huron 

Buffalo 


- 6 
-10 

- 8 







The July averages are hardly at all affected, the maxima 
decidedly more; the January means are raised as much 
as four degrees by exposure to the winds from the lakes, 
and the minima are as much as 10 degrees milder. 

Marquette is 13 degrees milder than Port Arthur in 
January, whereas the difference should be only about 
6; the difference of the average minima is 17 -degrees. 
Similar but smaller contrasts may be noted between 
Port Stanley and Cleveland, Toronto and Oswego. 

The cool summer in. the Upper Lake Region causes 
the vegetation to be of a more northerly type than we 
find either to the east or west. The important July 
isothermal of 68 degrees, which rises from southwestern 
Maine to the Ottawa River, dips down into central 
Michigan, to rise again, after reaching Wisconsin, into 
northern Minnesota. The moderating influence of the 
lakes has therefore bad as well as good sides, for certain 
crops cannot be successfully raised in northern Michigan, 
that thrive in similar latitudes in Minnesota and eastern ' 
Ontario. For our purposes, however, this climatic 
peculiarity is of the greatest value, since it affords a 
great number of cool summer resorts in latitudes that 
would otherwise be unpleasantly warm; but for the 



CLIMATOLOGY OF NORTH AMERICA 



73 



lakes, the inhabitants of the central states would be 
obliged to travel to. the Atlantic Coast for a breath of 
cool air in hot summers. 

The Ohio Valley. The Ohio Valley is intermediate in 
climate between the Atlantic States and the Mississippi 
Valley, but nearer the latter; it differs widely from that of 
the Lake Region. Little description in detail is necessary, 
for the following table supplies all the required data : 





a) 

+3 

o3 


+3 

'3d 
a 

. o 


el 

"o! 


>> 

C 


>. 
S 


-5 
O 




>> 

93 


a; 
C 


_>. 


3 


s 

+3 

ft 


s 

C 

o 


.a 

£ 


u 

£ 

<L 

o 


(4 

o3 




J 


i-) 


W 


*-3 


l=R 


§ 


< 


£ 


|-s 


HS 


< 


X 


o 


z 


H 


>■ 


Pittsburg (C) 


40.5 


80.0 


840 


31 


33 


39 


51 


62 


71 


75 


73 


67 


55 


43 


35 


52.9 


Parkersburg 


39 3 


81 5 


640 


32 


35 


41 


52 


63 


71 


75 


73 


66 


55 


44 


35 


53 5 




40.0 
39.1 


83.0 

84.5 


820 
570 


28 
33 


32 
36 


39 
42 


51 
55 


62 
65 


71 
74 


75 
78 


73 
76 


66 

68 


54 
56 


41 
44 


33 
37 


5? 1 


Cincinnati (C) 

Louisville (C) 


55.3 


38,2 


85 6 


530 


34 


38 


45 


56 


66 


75 


79 


77 


69 


58 


45 


38 


56 7 


Indianapolis (C) 


39.8 


86.2 


760 


28 


32 


40 


53 


64 


72 


76 


74 


66 


54 


42 


33 


52.9 



The seasons are considerably earlier inland than on the 
lakes; note that Columbus is five degrees warmer than 
Cleveland in April, and only one degree in October. 
The following table gives the extremes and daily range : 





Average 


Extreme 


Daily. Range 




(Max. 


Min. 


Max. 


Min. 


January 


July 


Pittsburg .... 
Columbus . . . 
Cincinnati . . . 
Louisville. . . . 
Indianapolis . 


97 
97 
96 
98 
96 


- 4 

- 7 

- 3 

- 1 
-10 


103 
104 
105 
107 
106 


-20 
-20 
-17 
-20 
-25 


24—39 
20—36 
26—41 
26—42 
21—36 


65—85 
65—86 
68—88 
69—90 
66—86 



Observe the great heat of the summer afternoons and 
the low minima in winter, which may fall below -30 in 
rural districts, lower than at most points on the lakes; 
Indianapolis has more severe cold than Grand Haven, 
200 miles to the north. 



74 



THE CLIMATIC TREATMENT OF CHILDREN 



The daily variability in the Ohio Valley is remarkably 
great for the semi-southerly latitude: 



Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
. Degrees 


Autumn, 
Degrees 


Year, 
Degrees 


7.1 


5.4 


3.2 4.9 


5.2 



The rise of temperature from Moose Factory on James 
Bay to Parkersburg, 800 miles to the south, is the most 
rapid in' the world for the distance; for each degree of 
latitude it amounts to 3.2 degrees in January, 1.3 in 
July, and 2.1 for the year. The total equals that be- 
tween the North Cape and Naples, which are 2,000 miles 
apart, 30 degrees in latitude as compared with 12. 

The Upper South. The most natural division between 
tjie upper and lower South is marked by the vegetation. 
In the upper South the forest growth is similar to that 
of Ohio and Virginia, being composed almost entirely 
of deciduous hard woods, only in somewhat greater 
variety; in the lower South we have vast forests of 
long- leaved pine, intermingled with a few broad-leaved 
deciduous and evergreen trees; toward the coasts the 
broad-leaved evergreens gradually become more con- 
spicuous, and the characteristic plants are the live oak 
and palmetto. The dividing line runs from Cape Henry, 
at first near the coast, then inward to central South 
Carolina and Georgia, dropping almost to the 32d 
parallel in Alabama, Mississippi and Louisiana. We 
therefore expect to find, in the upper South, a climate 
similar to that of the Ohio Valley, only of course warmer, 
in proportion to the difference in latitude; we shall see 
that the extremes are relatively much the same in both 
districts. 



CLIMATOLOGY OF NORTH AMERICA 



75 



I give the following table : 



Nashville (C) 
Knoxville . . 
Raleigh .... 
Asheville . . . 
Charlotte . . . 
Memphis . . . 
Little Rock . 
Atlanta .... 



36.2 
35.8 
35.8 
35.5 
35.2 
35.1 
34.8 
33.8 



86.8 
83.8 
78.6 
82.5 
80.7 
90.1 
92.3 
84.4 



550 

1000 

.380 

2250 

770 

340 

360 

1110 



45.52 



59.3 
57.2 
59.1 
54.6 
59.9 
61.3 
61.5 
61.4 



The following table gives the extremes and daily 
range : 





Average 


Extreme » 


Daily Range 




Max. 


Min. 


Max. 


Min. 


January 


July 


Nashville .... 
Knoxville .... 
Charlotte .... 

Memphis 

Atlanta 


97 
96 
98 
98 
96 


+3 
+3 
+9 

+8 
+9 


104 
100 
102 
104 
100 


-13 
-16 

- 5 

- 9 

- 8 


30—47 
29—48 
32—51 
33—49 
35—52 


70—90 
65—87 
68—88 
72—91 
69—87 



In January the days nowhere average really mild, 
and the nights range mostly about the freezing point; 
the summer days* are uniformly hot. The extreme 
minima are phenomenally low for the latitude, corres- 
ponding to that of Algeria, and the absence of subtrop- 
ical vegetation is thus easily accounted for; the daily 
variability is also excessive, at least in winter. 



Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 


Year, 
Degrees 


6.5 


4.9 


2.6 


4.3 


4.6 



Even Atlanta has less than eight months relatively 
free from killing frosts, and the entire region is sure to 



76 



THE CLIMATIC TREATMENT OF CHILDREN 



prove disappointing to such as seek a really mild winter 
climate. That season is, indeed, rather trying, for spring 
days alternate with zero, weather, such monthly ranges 
as 75 degrees being far from uncommon. The summer 
in the lowlands is nearly as hot as in the extreme south, 
only shorter; the finest months are March, April, October 
and November, above 1,500 feet also May and September; 
but only southerners would call the summer at such places 
as Asheville comfortably cool, for its mean temperature 
is higher than that of Boston or Chicago, the nights 
being somewhat cooler, the days considerably warmer. 

The Lower South. This section is much milder in 
winter, the conditions becoming those of the warm tem- 
perate zone. Two subdivisions may be distinguished 
by their characteristic vegetation, namely, the pine and 
palmetto belts; in the former the subtropical flora is only 
partially developed, for the winter minimum still regu- 
larly falls to- about 15 degrees, and occasionally to zero. 

The Pine Belt 



Augusta .... 
Montgomery 
Vicksburg . . 





T3 

' '5b 

a 

O 

•-1 


> 


>> 

a 

G 

a 


>> 

ci 
u 


o 

S-i 

3 


ft 

< 


£ 
§ 


0) 




a 

< 


S 
a 


V 

O 

o 
O 


-a 
S 

1 


s 
s 


33.5 
32.4 
32.4 


'81.9 
86.3 
90.6 


180 
220 
250 


47 

48 
48 


50 
52 
53 


56 
58 
59 


64 
66 
66 


72 
73 
73 


78 
79 
79 


81 
81' 
81 


79 
80 
80 


74 
75 
75 


64 
65 
65 


54 
55 
55 


48 
50 
50 



63.9 
65.2 
65.3 



The Palmetto Belt 



Hatteras 

Wilmington 

Charleston ..".... 

Savannah 

Jacksonville 

Mobile 

New Orleans (C). 



35.2 
34.2 
32.8 
32.1 
30.3 
30.7 
30.0 



75.5 
78.0 
79.9 
81.1 
81.6 
88.0 
90.1 



586269 



54 59 
57 62 



67 



76 1 67 



61.3 
63.1 
65.8 
66.4 
69.0 
66.7 
68.8 



CLIMATOLOGY OF NORTH AMERICA 



77 



The following figures will give an idea of the extremes 
and daily range in this region : 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


January 


July 


Augusta 

Montgomery . 
Vicksburg . . . 

Hatteras 

Wilmington . . 
Charleston . . . 
Jacksonville. . 

Mobile 

New Orleans . 


100 
99 

98 

89 
97 
98 
98 
98 
95 


+ 16 
+ 16 
+ 16 

+ 18 
+ 17 
+ 20 
+ 24 
+ 20 
+ 25 


105 
107 
101 

92 
103 
104 
104 
102 
102 


+ 3 

- 5 

- 1 

+ 8 
+ 5 
+ 7 
+ 10 

- 1 
+ 7 


37—57 
38—58 
39—57 

41—52 
38—56 
43—58 
46—65 
43—60 
47—62 


71—91 
71—91 

72—90 

73^-82 
73—88 
76—88 
74—90 
73—89 
75—90 



The winter days average mild throughout, but these 
figures are most deceptive, for the extreme minima pre- 
sent a very different picture; the combination of gen- 
erally spring-like conditions with occasional frosts of 
great severity makes the southern winter rather danger- 
ous as well as trying. Even in New Orleans the tem- 
perature fell below the freezing point in 24 winters out 
of 30; the minimum of —1 at Mobile in February 1899, 
is one of the most remarkable events in the history of 
that city; in the pine belt zero weather occurs about 
once in a decade. 

The variability of the temperature is as great, in winter, 
in Georgia as in New Jersey, but the summer is much 
steadier; the average figures for the lower south are: 



Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 


Year, 
Degrees 


5.8 


3.9 


2.0 3.6 


3.8 



The remarkable eccentricity of the southeastern winter ] 
unique in so low a latitude, is due to a moderate number 
of cold waves, accompanying the descent of a 



high- 



78 



THE CLIMATIC TREATMENT OF CHILDREN 



pressure area from Montana to Texas, in the wake of a 
storm crossing the Gulf S tat es . The " high ' ' travels south 
in 24 to 36 hours, causing a severe " norther " in Oklahoma 
and Texas, followed within another 24 hours by severe 
frost as far south as central and even southern Florida. 

The very severe spells occur at long intervals; the 
temperature has gone as low as 20 degrees at Jackson- 
ville on seven occasions in thirty years; no severe freeze 
occurred in the eight winters from 1887 to 1894, but two 
took place in the subsequent season, ruining the citrus- 
fruit industry for years to follow. 

Florida. The peninsula of Florida marks the transi- 
tion from the temperate zone to the tropics. - The 
vegetation of the latter, having made only the feeblest 
beginning in extreme southeastern Georgia, becomes 
dominant south of Titusville and Tampa, though the 
tenderest types cannot withstand the occasional sharp 
frosts of even the southern end of the peninsula, and 
are found only on the outermost keys. 

The temperature at various points is as follows: 



Tampa 

Jupiter 

Key West (C) 



28.0 
27.0 
24.6 



82.5 
80.0 
81.8 



71.6 
72.9 
77.1 



The extremes and daily range are : 








Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


January 


July 


Tampa 

Jupiter 

Key West .... 


94 
93 
91 


+ 30 
+ 36 
+ 50 


96 
96 
94 


+ 19 

+ 24 
+ 41 


50—70 
58—72 
66—75 


74—91 
76—87 
80—88 



CLIMATOLOGY OF NORTH AMERICA 79 

Killing frost occurs in three winters out of four at 
Tampa, and in one out of three at Jupiter; it is unknown 
at Key West. From May to October the climate is 
about as enervating as can be imagined. The reader 
will have observed that, from Cape Hatteras southward, 
the daily range is greater in winter than in summer; 
this is due to the change in direction of the prevailing 
winds, outlined at the commencement of this chapter. 
The South Atlantic Coast has, in fact, a well-developed 
monsoon system of winds, which is associated, as we 
shall see, with corresponding peculiarities in the seasonal 
distribution of humidity and rainfall; the land winds, 
that prevail from November to April, give way to sea 
winds during the warmer months. North of Norfolk 
west winds predominate throughout the year, south of 
Jupiter the northeast trade winds blow perennially; the 
northward movement of the latter begins in April, pro- 
gresses slowly until the northern limit is reached late 
in August, is followed by a stationary period until late 
October, and a rapid retreat during November. They 
do not in any case extend beyond the foothills of the 
Alleghanies or west of Alabama. 

The rise of temperature, from Parkersburg to Key 
West, for each degree' of latitude, is 2.5 degrees in 
January, 0.3 in July, and 1.4 for the year, therefore much 
less than in the north, especially in summer, but still 
considerable for the warm temperate zone. 

Before quitting the southeastern regions, We must take 
a passing glance at certain insular localities, that belong, 
'in a measure, to this section. 

The Bermudas and Bahamas. These groups of small 



80 



THE CLIMATIC TREATMENT OF CHILDREN 



islands are of no little interest to the medical climatol- 
ogist, and merit considerable attention. We have the 
following data from the Bermudas : 







'So 
c 
o 
i-5 


c 
o 

£ 


>> 

u 

a 

3 

G 

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77 


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64 


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32.4 


64.7 


50 


62 


61 


62 


64 


69 3 







Though opposite Charleston, the winter is very much 
warmer, the summer but a trifle cooler, the usual range 
of temperature is from 90 to 48 degrees; frost is ex- 
tremely rare, as are temperatures above 92. The course 
of the seasons is oceanic, midwinter falls as late as the 
middle of February, and midsummer well on in August; 
the uncomfortable heat lasts until late October, whereas 
May is still very tolerable. 

Our data from the Bahamas are scanty; the tempera- 
ture at Nassau averages 71 degrees in January, and 82 
in July and August, with an annual mean of 76.5; the 
chief difference from Miami, Fla., directly opposite, is a 
somewhat warmer winter, with the total absence of frost. 

Cuba is outside of our field, but as Havana lies only 
twenty miles within the tropics, I give a set of .figures, 
for the sake of comparison. 



Havana 



23.1 



82.4 



60 



71 



72 



73 75 



78 



80 



81 



81 80 



77 



74 



71 



76.1 



The relatively cool summer is due to the exposure 
of the city to the northeast trade winds. The lowest 



CLIMATOLOGY OF NORTH AMERICA 



81 



temperature in a fairly long series of observations was 49 
degrees, the mean minimum being 55 degrees, a tem- 
perature felt severely in this enervating climate. The 
average maximum in summer is 94 degrees. 

The Mississippi Valley, etc. We may begin our study 
of the middle and upper Mississippi Valley, and the 
regions lying to the north and west, as far as the 100th 
meridian, with a list of tabulated data. The outlying 
sections have been entered here because their type of 
climate is precisely similar. 



Cairo 

St. Louis (C) 
Kansas City. 
Des Moines . . 
La Crosse (C) 
St. Paul (C) . 
Moorhead. . . 

Wichita. 

Omaha 

Huron, S. D. 
Winnipeg . . . 



37.0;89.2 
38.6 90.3 
39.1 94.6 
41.6 93.6 
43.8 91.2 
45.0 93.0 

46.8 96.8 

37.7'97.4 

41.3 96.0 

44.4 98.2 

49.9 97.1 



360 
470 
960 
86t> 
710 
840 
940 

1360 

1100 

1310 

770 



39 47 
36 43 
32 40 
23 34 
20 31 
1628 
520 

35*43 
25 35 
1426 



59 67 75 
56166 75 
54 64 73 
5061 71 
47 59 69 
4557 67 
4l'53|64 

56J65 73 
51 62 71 
445767 
36 52162 



- K - 



s 



£ 

a. 
_ > 
ELL c 



70 59 46 39 
70 58 44' 36 
68 56 41 32 

64 51136:26 
62 49 33 23 
60;47,30il9 
57j43 2410 

6757143 35 

65 53l37;27 
59 46|29il7 
52 39 171 3 



57.7 
55.9 
53.2 
48.5 
46.0 
43.3 
37.6' 

54.7 
49.6 
42.3 
32.9 



The extremes and daily range in this region are as 
follows : 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


January 


July 




96 
98 
100 
98 
95 
95 
96 

101 

100 

101 

93 




- 5 
-11 
-19 
-25 
-27 
-35 

- 5 
-18 
-30 
-43 


106 
107 
106 
109 
104 
104 
102 

106 
106 
108 
103 


-16 
-22 
-22 
-30 
-43 
-41 
-48 

-22 
-32 
-43 
-54 


28—43 

24—38 

. 19—34 

10—26 

8—23 

4—19 

-9—+ 9 

■ 

20—38 

11—27 

- 1— + 19 

-17—+ 4 


70—88 


St. Louis ...... 

Kansas City . . • 
Des Moines. . . . 

La Crosse 

St. Paul 

Moorhead 

Wichita 

Omaha 

Huron 

Winnipeg 


70—89 
. 67—88 
64—86 
62—84 
61—82 
56—80 

66—90 

66—87 
58—84 
53—79 



82 



THE CLIMATIC TREATMENT OF CHILDREN 



In February 1899 —63 degrees were observed at 
Norway House in latitude 54; within a few days —29 
were recorded at Springfield, Mo., and —1 at Mobile, Ala. 

In Manitoba, frost is common in early June, and not 
very rare in the latter part of August. North of latitude 
45, the January nights regularly have temperatures be- 
low zero, but occasional brief spells of thawing weather 
may occur in midwinter at Winnipeg and beyond. 

The weather is exceedingly changeable everywhere, 
and nearly as much so in Missouri as in Manitoba, the 
average variability being: 



Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn; 
Degrees 


Year, . 
Degrees 


8.3 


5.8 


3.8 


5.6 


5.9 



At Winnipeg the mean monthly range is 72 degrees in 
January and 47 in July, and at St. Louis the correspond- 
ing figures are only about eight degrees less. 

The South Central States have the same type of climate, 
only warmer. 



Oklahoma. . . . 
Shreveport . . . 
Galveston (C) 
San Antonio. . 
Corpus Christi 



0> 



A 

35.4 
32.5 
29.3 
29.4 
27.8 


4> 
73 

3 

1 

97 5 
93.6 
94.8 
98.5 
97.5 


a 
_o 

> 

9 

m \ 

1210 
250 

50 
700 

20 


>) 

c3 

3 

a 

c3 

| -i 

36 
46 
53 
51 
56 


s 

3 

In 

.a 

0) 

41 
51 
57 
56 
59 


-a 

o 
o3 

49 

58 
63 
62 
64 


ft 
< 

60 
66 
70 
70 
70 


>> 

03 

m 

68 
73 
76 
76 
76 


d 

•-» 

75 
80 
82 
81 
80 


>> 

1-3 

79 

83 
84 
83 
82 


< 

77 
81 
83 
82 
81 


S 

ft 

a? 

w 

70 
75 
79 
77 
79 


S3 

O 
O 

O 

60 
65 
72 
70 

72 


B 
o 

48 
55 
63 
60 
64 


■s 

o 

Q 

41 
49 
56 
■54 

58 



58.7 
65.2 
69.8 
68.5 
70.1 



The extremes and daily range are: 




Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


Jan. 


July 




100 
101 

94 
102 

95 


- 1 

+ 15 
+ 25 
+ 18 
+ 25 


104 
107 

98 
108 

98 


-17 
- 5 
+ 8 

+ 4 
+ 11 


26—46 
37—55 
48—58 
41—62 
50—62 


68—90 


Shreveport 


73—94 
80—89 


San Antonio 

Corpus Christi 


73—94 

77—87 



CLIMATOLOGY OF NORTH AMERICA 



83 



All the absolute minima date from February 1899, 
when the thermometer fell to 31 degrees at Tuxpan, 
Mexico, in latitude 21, the farthest recorded southward 
extension of the frost line on our continent, at the sea 
level. 

Along the 98th meridian, the rise of temperature for 
each degree of latitude is as follows: 





January, 
Degrees 


July, 
Degrees 


Year, 
Degrees 




3.0 

2.2 


1.2 
0.0 


1.9 




1.2 







It will be seen that these figures are somewhat smaller 
than those given for the 81st meridian on pages 68 and 74. 
The mean variability of temperature in the South 
Central States is : 





Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 


Year, 
Degrees 




6.3 
5.1 


4.4 
2.6 


2.3 
1.3 


4 
3.2 


4.3 


Texas Coast . 


3.0 



The Texas Coast would enjoy a most even climate but 
for the occasional cold snaps (northers) which bring 
killing frost nearly every winter to the Rio Grande and 
beyond. The subtropical flora, as the minimum tem- 
peratures at Shreveport would suggest, barely reaches the 
32d parallel in Texas, and tender plants, such as the 
Magnolia grandiflora, endure the winter better at Rich- 
mond, Va., than at Fort Worth, five degrees farther 
south. Westward the subtropical vegetation gradually 
assumes the character of the so-called chaparral, con- 
sisting of partly evergreen thickets of live oak, mesquite 



84 THE CLIMATIC TREATMENT OF CHILDREN 

and aromatic shrubs, resembling the macchie of the 
Mediterranean region; this floral type characterizes the 
semi-arid subtropical regions of both hemispheres. On 
the lower Rio Grande we find the beginnings of the 
tropical flora of the Mexican lowlands, despite occasional 
freezing weather; it will be remembered that analogous 
conditions appear in Florida, only there the somewhat 
milder winter permits an extension a few degrees farther 
north. 

The Great Plains and the Rocky Mountain Slope. The 
Great Plains, while apparently level, nevertheless rise 
gradually westward, abput four feet to the mile on the 
50th, and eight on the 40th parallel. Slight as is this 
slope, it seems to be intimately connected with the cli- 
matic peculiarities of this region, which consist essen- 
tially in a rise of temperature, as we ascend. Thus, in 
Canada, Medicine Hat is 14 degrees warmer than Win- 
nipeg in winter, and 1 in summer, although it lies 1,400 
feet higher; similarly, Cheyenne is 6 degrees warmer 
than Omaha in winter, although its elevation is 5,000 
feet higher; its summer, while cooler, is far less so than 
the difference in altitude would 'call for, averaging only 
9 degrees lower, instead of at least 15. Near the moun- 
tains, this may, of course, be attributed to "foehn" 
winds, but the increase is so gradual, beginning as far 
east as the 96th meridian, that the above explanation 
does not cover the ground perfectly; we cannot see, for 
example, why the winter at North Platte, in the midst 
of the plains, should also be warmer than at Omaha, in 
spite of a rise of 1,700 feet. 

The following table gives the temperature data for 
this region: 



CLIMATOLOGY OF NORTH AMERICA 



85 



Abilene, Tex 

Amarillo 

Dodge City 

Denver .". 

North Platte 

Cheyenne 

Lander 

Rapid City 

Pierre 

Yellowstone Park 

Helena 

Bismarck , 

Williston 

Havre 

Medicine Hat. . . . 

Regina. 

Banff 

Prince Albert 
Edmonton 



32.4 
35.2 

37.7 
39.8 
41.1 
41.1 

42.8 

44.1 
44.4 
44.8 
46.6 
46.8 
48.2 



50.0 
50.4 
51.2 
53.2 
53.2 



101.7 

100.0 
105.0 
100.7 
104.8 
108.6 

103.2 
100.3 
110.5 
112.1 
100.8 
103.6 
109.7 

110.6 
104.6 
115.6 
106.0 
113.5 



1,740 
3,680 

2,510 
5,290 
2,820 
6,090 
5,370 

3,230 
1,570 
6,200 
4,110 
1,670 
1,880 
2 500 

2,160 
1,880 
4,540 
1,430 
2,160 



46 
35 

32 
32 
26 
27 
21 

23 

17 

• 20 

22 

10 

8 

15 

12 
-1 

13 
-3 



73 



*-l-° 

III 

«i o 
C 2 



64 52 45 
56 43 35 



62.7 
54.2 

53.1 
49.3 

47.8 
44.4 
41.7 

45.3 

44.7 
38.1 
43.1 
39.6 
38.2 
40.4 

40.1 
32.5 
34.6 
30.5 
35.7 



The prairies extend only as far north as the Saskatche- 
wan, farther on we enter the great subarctic forest which 
extends northwestward almost to the mouth of the 
Mackenzie River. The extremes and daily range on the 
Great Plains are as follows : 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


Jan. 


July 




102 
97 

102 

100 

97 

94 

100 

105 

' 95 

100 
99 

98 
88 
92 


+ 6 
- 4 

-12 
-20 
-14 
-19 

-24 
-25 
-26 
-34 
-36 

-49 
-46 
-54 


110 
105 

108 
107 
105 
100 

106 
113 
103 
106 
108 

92 

96 


- 6 
-16 

-26 
-35 
-29 

-38 

-40 
-40 
-42 
-44 
-55 

-57 
-70 


31—52 
19—42 

14—38 

8—32 

16—40 

15-36 

8—30 

2—23 

10—25 

-5— + 16 

0—21 

-16—+ 4 
- 6— +12 

-17—+ 1 


71 — 93 




64 — 88 


Dodge City 

North Platte 


65—91 
60—87 
58 87 


Cheyenne 

Rapid City 


53—81 

58—83 
62 -86 




56 — 79 


Bismarck 


57—81 
54—81 

50—- 78 




Edmonton 

Prince Albert 


49—73 
50—75 



86 THE CLIMATIC TREATMENT OF CHILDREN 

The reader will note the relatively warm days and 
cold nights. In January, Denver has the day tem- 
perature of Baltimore and the night temperature 
of Albany; in July we find the days as hot as at 
Washington and the nights as cool as at Quebec, the 
heat of the day being tempered by a phenomenally low 
humidity. 

The winter minima are astonishingly low. In Janu- 
ary, 1885, —63 degrees were registered at Poplar 
River, in northeastern Montana, and in February, 
1893, there was a record of —70 at Prince Albert. 
There is no doubt that figures as low as —75 and —80 
occur in far northwestern Canada, where —65 is quite 
frequent. 

The different seasons vary exceedingly from the normal 
temperature; thus, at Edmonton, within fifteen years, 
the average for November has been as high as 40 degrees 
and as low as zero ; for January, the figures for the same 
period are 22 and —13. At Winnipeg, February has 
averaged 24 (1878) and —16 (1875) degrees; similar 
climatic eccentricities have been repeatedly noted at 
Havre and other points at the foot of the Rockies. A 
succession of the winter storms of the first type, passing 
through the Canadian Northwest, causes. frequent Chi- 
nook winds and a high mean; the stagnation of high- 
pressure areas over this region, which is less frequent, 
produces the intense cold noted above. Changes of 30 
degrees in an hour when the wind shifts from southwest 
to north, and vice versa, are not at all rare on the moun- 
tain slopes, even so far south as western Texas; Greeley 
reports a rise of 47 degrees in 8 hours at Denver, and 
for Abilene there is on record a fall of 63 degrees in 16 



CLIMATOLOGY OF NORTH AMERICA 



87 



hours. The mean monthly range at Willis ton is 74 
degrees in winter, and 57 in summer. 
The daily variability for this region is quite uniformly : 



Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 


Year, 
Degrees 


7,5 


5.8 


'3.6 


5.4 


5.6 



In winter there is little difference between Montana 
and Texas, but the summer is much steadier south- 
ward. 

Before leaving the Great Plains, we may glance briefly 
at the distribution of a few of their more striking meteor- 
ological phenomena. Among these, the tornado easily 
ranks foremost, but is not altogether peculiar to this 
portion of the continent, being, in fact, rather uncommon 
west of the 100th meridian, and diminishing in force and 
frequency only gradually as the Atlantic Coast is ap- 
proached. Tornadoes are commonest in Missouri, Kan- 
sas, Iowa and Nebraska; then follow Illinois, the 'lower 
Mississippi Valley, Oklahoma and Texas; finally, the 
Ohio Valley, southern Minnesota and South Dakota. 
In the Atlantic States they are much less frequent and 
destructive. 

Hot winds are not so frequent as is often supposed, 
and only exceptionally, as in the unusually dry and hot 
July of 1901, reach so far east as the Mississippi River. 
Toward the Rocky Mountains they become common, but 
even here are rarely so hot and dry as in Arizona, Cali- 
fornia, and the Snake River Valley. Temperatures 
above 105* degrees are quite rare, save at such localities 
as Pierre, which is situated to the north of a plateau, 



88 THE CLIMATIC TREATMENT OF CHILDREN 

where the south winds, already warm, are still further 
heated and dried dynamically in descending. 

The third specialty of the Plains is the blizzard. It has 
recently become the fashion to call every violent snow- 
storm a blizzard, but the true blizzard, with fine dust-like 
snow, a fierce gale, and a temperature rapidly falling to 
zero and below is almost entirely confined to this region, 
prevailing in the Dakotas, Montana, Nebraska and the 
eastern halves of Wyoming and Colorado, less often Kan- 
sas. In the far north, it attracts less attention, chiefly 
perhaps because the inhabitants are pretty thoroughly 
accustomed to severe weather. The heavy snowstorms 
east of Nebraska and the Dakotas hardly partake of 
the irresistibly fatal character of the true blizzard. 

For a more minute description of the above phenom- 
ena, the reader is referred to works on meteorology; it 
would be out of place in a book of this kind. 

We have now completed our survey of the temperature 
conditions east of the continental divide, and may 
begin the consideration of the West with 

'The Western Plateau. Our knowledge of this region 
is less complete than might be desired, good records 
being absolutely wanting north of the 53d parallel, and 
scattered and scanty elsewhere, especially in the less 
settled districts. The southwestern plateau is excluded 
from consideration here, its climate differing from the 
region north of the 37th parallel in many respects. The 
following averages have been corrected as carefully as 
possible by comparison with the long-established ones, 
which number only about eight, even if a few just outside 
of the district are included : . 



CLIMATOLOGY OF NORTH AMERICA 



Carson City 

Salt Lake City... . 
Winnemucca 

Leadville 

Grand Junction. . 
Durango 

Pocatello 

Boise" City 

Baker City 

Walla Walla 

Spokane 

Kalispell 

Kamloops 

Barkerville 



39.2 
40.7 
41.1 



119.8 
111.9 
117.7 

103.3 
108.6 
107.9 

112.5 
116.2 
117.8 
118.3 
117.4 
114.4 

120.5 
121.9 



4720 31 35 40 ! 47 o4 ! 6l!6766 59 5040 34 48 . 7 
4370 128 34 42 50 58 67 75 74 64 52 40 32 51 .3 
4340 27 33 40 47 55 63 71 70 60 49 37 31 '48 .6 



10220 
4610 
6550 

4480 
2740 
3470 
1000 
1940 
2960 

1190 
4180 



913120 
24J30I41 
24 28 36 



28:37|45 
52163 71 
45154 61 



30|38|4654 
5l!59 



52 
61167 

5763 
52 58 

5764 
43 51 



50 42 
76 65 
66J58 

7059 

71 61 
64J56 

72 64: 
68159 
63|54 

68 58 
5547 



322014 

523729 
473428 

4735 27 
50 3S 32 
46 35i26 
54 42 35 1 
4938J30 
44 31 24 

48^5 28 
38,26121 



30.2 
51.5 
45.7 

47.0 
50.7 
44.2 
52.5 

47.8 
41.9 

47.1 
36.2 



The relatively high temperature of this region will be 
best appreciated by. reference to maps of isothermal lines; 
it will be noticed,- how T ever, that the winter at first grows 
somewmat colder, when we cross the continental divide, 
so that western Colorado and Wyoming, also eastern 
Idaho and adjoining Montana are colder than the regions 
on either side. The distribution of temperature is in 
any case less uniform than on the eastern side of the 
continent, and there are many local warm and cold 
climatic islands, according to the situation of the indi- 
vidual localities. In western Colorado it is of interest 
to note the rapidly increasing heat in summer from 
Durango to Grand Junction, due to descending air cur- 
rents from the southeast. The following records afford 
an idea of the extremes and daily range of temperature : 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


Jan. 


July 


Carson City 

Salt Lake City, . . . 

Winnemucca 

Boise" City 

Walla Walla 

Spokane 


94 
98 
97 
104 
104 
99 


- 5 

- 3 
-10 

- 6 

- 4 
-12 


100 
102 
104 
111 
113 
104 


-22 
-20 

-28 
-28 
-17 
-30 


19—43 
* 21—36 
17—37 
22—37 
24—36 
18—30 


51—83 
62—88 
55—88 
58—89 
60—86 
56—82 



90 



THE CLIMATIC TREATMENT OF CHILDREN 



The most marked difference between the two slopes 
of the Rocky Mountains is in the variability of the 
temperature, which is less than two-thirds as great in 
winter on the west as on the east side; the following 
figures prevail quite uniformly throughout : 



Winter, 
Degrees 


Spring, 
Degrees 


Summer 
Degrees 


Autumn, 
Degrees 


Year. 
Degrees 


4.5 


. 4.0 


3.3 


3.9 


3.9 



It is therefore all the more surprising to note the occa- 
sional intense cold at stations so mild as Salt Lake City 
and Walla Walla, not to speak of — 28 degrees at Boise 
City. These cold waves are very exceptional, and the 
usual minima barely touch zero; they are due to the 
very uncommon stagnation of a high-pressure area over 
the northern plateau, while the Great Basin itself is 
snow covered. The same phenomenon occurs in Central 
Europe under analogous conditions. 

The daily range in winter is relatively small, as this 
is the rainy season west of the divide; in summer the 
range is enormous, the nights are cool and the days very 
hot, this season being almost rainless. 

As we ascend the mountains, the fall in temperature 
is very rapid, as seen on Pike's Peak, for example. 





Elev., 
Feet 


Jan., 
Degrees 


April, 
Degrees 


July, 
Degrees 


Oct., 
Degrees 


Year, 
Degrees 


Summit 

Colorado Springs. . . 


14130 
6060 


3 

27 


13 

46 


39 
70 


22 

48 


19.2 

47.8 


Difference 

" per 


8070 
1000 


24 
3.0 


33 
4 .1 


31 

3.8 


26 
3.2 


28.6 
3.5 



We see how greatly this rate exceeds that in the 
Alleghanies; it is, however, very much less on the 



CLIMATOLOGY OF NORTH AMERICA 



91 



western slope of the Rockies, at least in winter, when 
inversion of temperature is quite frequent on that side. 
The tree line is remarkably high for the latitude in 
Colorado, 11,500 feet; the snow line is touched only by 
the highest peaks, and there are no glaciers of any con- 
sequence south of the Canadian border, until we ap- 
proach the Pacific Coast. 

The Southwest. Extreme southern Utah and Colorado, 
with the adjoining portions of Arizona and New Mexico, 
form a vast high plateau, deeply grooved by the canon 
of the Colorado. Passing southward from this table- 
land we enter a region geographically, as before 1846 
also politically, belonging to Mexico. This relation is 
shown by both the flora and the climate; as we descend, 
the temperature rises very rapidly, and the distribution 
of moisture, as we shall see later, becomes quite different 
from that prevailing farther north, east, and west. 

The Upper Rio Grande Valley and Arizona first claim 
our attention, and the following table will supply suffi- 
cient and reliable data as to the temperature : 



Santa Fe 
El Paso. . 

Prescott . 
Phoenix . 



35.7 
31.8 



34.5 
33.5 



106.0 
106.5 



112.5 
112.0 



7010 
3760 



5390 
1110 



54 



47 56:65 68 66 60 50 38 31 48.3 
64 73 ! 80 82 79 73 63 52 46 63.4 



59 67 
75 83 



73 71 
90 88 



63 54 

81 70 



42 35152. 2 
59 52J69.1 



The climate of the Mexican plateau is so similar that 
we may most conveniently refer to it here; Mexico City, 
though situated in the tropics, is rendered temperate by 
the altitude, and may therefore likewise be added. 



92 



THE CLIMATIC TREATMENT OF CHILDREN 





d 
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Chihuahua 

Saltillo 

Mexico City 


28.6 
25.6 
19.4 


106.5 

100.5 

99.1 


5400 
4670 
7470 


50 
51 
54 


54 
54 
57 


61 
60 
60 


69 

66 
64 


76 
71 
65 


79 

75 
64 


79 
71 
62 


73 
71 
62 


71 

69 
61 


65 
63 
59 


57 
56 
56 


52 
51 
54 


65.5 
63.2 
59.7 



At El Paso, August is cooler than June, south of 
Chihuahua July also becomes cooler, and in central 
Mexico May becomes the warmest month. This shift- 
ing of the period of greatest heat is connected with the 
development of the rainy season. 

The following table gives an idea of the extremes and 
daily range: 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


Jan. 


July 


Santa Fe 


90 
102 

95 
113 

85 


- 2 

+ 11 
+ 1 
+ 24 

+ 33 


97 
108 
100 
119 


-13 
- 5 
-18 

+ 12 


18—38 
31—58 
20—45 
37—64 

41—67 


57 — 79 


El Paso 


£9 — 95 


Prescott 

Phoenix 

Mexico City 


58— 89 
76—105 

May 
52— 78 



The summer days are hot, but in the upland sections 
the nights are always comfortably cool; in the lowlands 
high temperatures prevail both day and night. The 
winter weather resembles that in the Great Basin, but 
is drier and has a greater daily range, with of course also 
a rapid rise of the average temperature as we go south 
and descend into the deeper valleys of the Gila and Rio 
Grande rivers. 

The daily variability is quite small, as follows : 



Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 


Year, 
Degrees 


4.0 


3.8 


2.4 


3.1 


3.3 



CLIMATOLOGY OF NORTH AMERICA 



93 



In the low valleys the summer temperature is very 
steady, with a maximum around or above 100 degrees 
every day for months. 



The lower Gila Valley marks the transition to the 
deserts of southeastern California; for the latter section 
we have official records for Yuma and Independence. 
I have corrected the semi-official data for Salton to the 
Yuma standard, and the resulting figures are at least 
approximately correct; while apparently altogether too 
high in summer, they agree very closely with the results 
obtained by the U. S. Government's Death Valley 
expedition. 







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Salton 

Independence .... 


32 6 
33.5 
36.8 


114.6 
115.9 
118.2 


140 

-250 
3910 


54 

52 
40 


58 
57 
44 


64 
65 
50 


70 

75 
57 


77 
85 
65 


85 
95 
73 


92 

102 

80 


91 
100 

78 


84 
92 
70 


73 
80 
60 


62 
67 

48 


56 
58 
43 


72.2 
77.3 
59.0 



In the depression at Salton, the summer is the hottest 
known in the world; 128 degrees have been recorded 
and 120 occur for days at a time. Death Valley averages 
only about two degrees cooler at all seasons; at Yuma 
the ordinary extremes are 114 and 28 degrees, the 
absolute extremes 118 and 20, the daily range is from 
41 to 68 in January, and from 77 to 108 in July, when 
the afternoon maximum almost invariably exceeds 
100. 

Salton is only ninety miles from the coast, where the 
July temperature is 35 degrees lower; this is the great- 
est contrast of temperature known, but the transi- 
tion is not very uniform, being gradual and moderate 



94 



THE CLIMATIC TREATMENT OP CHILDREN 



from the coast to the Coast Range of mountains, on the 
east side of which the increase of heat is very sudden. 

On the west coast of Mexico we have trustworthy 
figures only from Mazatlan, just within the tropics. 





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106.4 


30 


68 


68 


70 


73 


77 


81 


83 


84 


84 


81 


76 


71 


76 3 









Topolobampo, in latitude 25° 3', averages about 64 
degrees in January, and 86 in August; Guaymas, in 
latitude 28°, about 60 in January and 90 in August. 

The interior of Sonora resembles southern Arizona, 
but is a little warmer in winter. No part of northwestern 
Mexico has as yet advanced sufficiently in civilization 
to attract the health-seeker and ordinary tourist. 

The Pacific Coast. We may begin our consideration 
of the climate of the Pacific Coast with southwestern 
California. As mentioned above, this section presents 
a most striking contrast to the desert behind the Coast 
Range. The temperatures for southwestern California 
are: 





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32.7 
33.4 
34.1 
34.4 
36.6 


117.2 
118.4 
118.2 
119.7 
122.0 


90 

50 

340 

130 

100 


54 
54 
53 
53 
50 


55 
54 
55 
54 
51 


56 
55 
57 
55 
52 


58 
56 
59 
56 
54 


61 
57 
62 
59 
56 


64 
59 
66 
62 

58 


67 
60 
69 
64 
60 


69 
61 
70 
66 
61 


67 
60 
68 
64 
60 


63 
59 
64 
61 
57 


59 
57 
59 


56 

55 


60 7 


Santa Catalina Island. 


57.2 
61 4 


Santa Barbara 


58 55 
54 52 


58.9 
55.4 











August is everywhere the warmest month, and Sep- 
tember is often as warm as July. Owing to the hilly 
character of the country, the sea breeze does not 



CLIMATOLOGY OF NORTH AMERICA 



95 



penetrate freely into the interior, and we find there an 
increased warmth in spite of a considerable elevation. 
On the other hand, the hot winds, in a modified form, 
sometimes reach the coast itself, as shown in the follow- 
ing table of extremes: 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


Jan. 


July 


San Diego 

Los Angeles 


90 
100 


+ 37 
+ 33 


101 
109 


+ 32 

+.28 


46—62 
43—64 


63—72 

58—81 



The outer islands are, however, entirely exempt from 
very warm weather; they enjoy an eternal spring, in win- 
ter they resemble early May in New York, in summer 
the latter part of May, of course in temperature only. 
Toward the middle Californian region, the climate also 
becomes singularly even, as at Monterey, where we find 
a transition to the San Francisco district. 

Lower California seems to have a uniform climate in 
winter, January averaging about 55 degrees in the 
north, and 65 in the extreme south; in summer the 
west coast is cool, ranging from about 70 degrees in the 
north to 75 in the south, but the east coast grows very 
hot toward the head of the Gulf of California,, with a 
July average of 90 degrees. All these figures are, of 
course, mere estimates, as no accurate records are 
extant. 

As a striking contrast to the coast and deserts just 
described, we may note the rather severe mountain 
climate in the Sierra Nevada. At Lake Tahoe, 6,200 
feet high, January averages about 26 degrees and July 62, 
with annual extremes of about 90 and — 15. Frost is 
not very rare in midsummer; nevertheless, in warm sum- 
mers after dry winters, nearly all the snow disappears 



96 



THE CLIMATIC TREATMENT OF CHILDREN 



from the very highest peaks. In northern California, 
the snow line drops to about 11,000 feet, and Mt. 
Shasta is capped with ice fields and glaciers. 

About San Francisco Bay we find a most remarkable 
distribution of temperature, altogether unique; the fol- 
lowing table will serve as an introduction : 



SE. Farallone 

San Francisco (C) . 

Oakland (C) 

Mt. Tamalpais. . . . 



37.7 
37.8 
37.8 
38.0 



123.0 
122.5 
122.3 
122.7 



W 



30 

100 

70 

2370 



53.3 
56.0 
56.7 
57.1 



On the Farallone Islands there is an annual range of 
only seven or eight degrees, September being the warmest 
month, and October being warmer than July; the same 
type of climate prevails at San Francisco, save that the 
range has increased to eleven degrees. This curious 
course of the temperature is due to the suppression of 
the normally increasing summer warmth by the violent 
and continuous sea breeze; when this begins to abate, 
in the autumn, the mean temperature rises, and an 
occasional hot wind reaches the coast from the interior. 
Hot weather may occur in May, June, September and 
October; it is extremely rare in July and August. The 
following table will illustrate this curious anomaly: 





May, 
Deg. 


June, 
Deg. 


July, 
Deg. 


Aug., 
Deg. 


Sep., 
Deg. 


Oct., 
Deg. 


Average maximum, 30 years 


80 


82 


79 


78 


85 


82 



At Oakland, across the bay, but only five miles from 
San Francisco, conditions are quite different; the 
warmest month is no longer September, but August, as 



CLIMATOLOGY OF NORTH AMERICA 



97 



elsewhere in California, and a few hot days are not so 
uncommon in midsummer. Oakland begins to grow 
warmer than San Francisco in April and May, is five 
degrees warmer in summer, but has the same tempera- 
ture in and after October. 

In ascending to the siimmits of .the Coast Range, as at 
Mount Tamalpais, we find that the sea breeze has dis- 
appeared, for it does not reach to this height. The sum- 
mer is proportionately much warmer than even at Sacra- 
mento; San Francisco people ascend the mountains in 
summer for the sake of greater warmth, instead of cool 
weather, as elsewhere. Localities under the lee of the 
Coast Range, as San Rafael, are also relatively warm in 
summer, but I have not been able to secure reliable data 
concerning this popular resort. 

The average extremes at San Francisco are 90 and 
36, the absolute extremes 101 and 29 degrees; killing 
frost is even rarer than hot weather. In January the 
daily range is from 45 to 56 degrees, in July from 52 to 
64, and in September from 55 to 68. 

The coast of northern California has a very similar 
climate, but the Coast Range is sufficiently high and con- 
tinuous to cut off all hot winds. August is the warmest 
month, though September still equals July. The annual 
range is exceedingly small for the latitude. The follow- 
ing data for Eureka will give ample information ; 





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124.2 


60 


46 


47 


48 


50 


52 


54 


56 


57 


56 


53 


50 


4S 


51.4 







The ordinary extremes are only 75 and 28 degrees, 



98 



THE CLIMATIC TREATMENT OF CHILDREN 



the absolute extremes 84 and 20; the daily range in 
January is from 40 to 53 and in August from 52 to 62. 
It is interesting to compare these figures with those of 
New York, in exactly the same latitude on the Atlantic 
Coast, the annual means being almost identical. 

Along this entire coast, the summer actually appears 
colder than the winter, on account of the penetrating 
winds and damp fogs at the former season. 

The interior of California has a climate that partakes 
of some of the features of the deserts. 





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36.7 
38.6 
40.2 


119.7 
121.5 
122.3 


330 

70 

330 


44 
46 
45 


49 
50 
50 


55 
54 
55 


61 
59 
61 


68 
64 
68 


76 
69 
75 


82 
73 
81 


82 
73 
81 


75 

69 
74 


65 
62 
65 


54 
53 
55 


46 

47 
47 


63 1 




59 9 


Red Bluff 


63 1 







Observe how the summer grows warmer as we depart 
from San Francisco Bay either to the north or south, 
also the extreme uniformity of the temperature in 
winter. 

The following table gives the extremes and daily 
range of temperature in the interior of California : 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


Jan. 


July 


Fresno 

Sacramento 

Red Bluff 


110 
104 
109 


25 

28 
26 


115 
110 
115 


20 
19 

18 


35—53 
39—54 
37—53 


65—100 
58— 88 
67— 96 



Severe frost is unusual, and the minima are higher 
than in northern Florida. The parching drought and 
hot winds of the summer are very trying, in spite of 



CLIMATOLOGY OF NORTH AMERICA 



99 



the extremely low humidity; the nights are, however, 
tolerably cool. Red Bluff is phenomenally warm at all 
seasons, owing to its exceptionally sheltered situation; 
Sacramento, as already stated, has its summer heat 
somewhat mitigated by a remnant of the sea breeze, of 
course with a slight increase of humidity. 

The variability of the temperature on the whole 
Pacific Coast is small; even if we go some distance inland, 
we find, in particular, a very steady winter climate. The 
figures are : 





Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 


Year, 
Degrees 


Coast 

Inland 


2.2 
3.2 


2.0 
3.2 


1.6 
3.1 


2.2 
3.2 


2.0 
3.2 



Note the small seasonal differences. 

North of California, the Coast Range becomes very 
much broken by river valleys, so that the difference in 
climate between the coast and the interior becomes 
materially diminished. The maximum temperatures 
are no higher than in the Atlantic States, and severe 
frosts may, exceptionally, reach the shores of the Pacific 
Ocean. In the main, however, oceanic conditions still 
persist, as westerly winds prevail everywhere in summer, 
and are very frequent in winter. 

The following table will give ample thermometric data : 



Astoria 

Tatoosh Island. 

Roseburg 

Portland (C). . . 
Seattle (C) 



46.2 
48.4 

43.5 
45.5 
47.6 

Victoria 148.4 



123.8 
124.8 



90 



123.4 520 40 
122.7 90 39 

122.3 120 40 

123.4 8038 



4245 49 53 57 
42,44 47,50 53 

43 47^5l' 56 61 
42 47 52 57 62 
42 46 50 55 59 

39 42 47 52 57 



62 59 53 47 43 51.0 
56 53 50 46 43 48 . 4 

66W53 46 43 52.7 
66 60 53 46 42|52 7 
62 57 51 45|42 50.9 

59 55 49 43' 40 48.4 



Lwa 



100 THE CLIMATIC TREATMENT OF CHILDREN 

The extremes and daily range are: 





Average 


Extreme 


Daily Range 




Max. 


Min. 


Max. 


Min. 


Jan. 


July 


Roseburg 

Portland 

Tatoosh Island.. . 


98 
95 
75 

83 


18 
15 
23 
16 


106 

102 

80 

90 


-6 
-2 
+ 7 
-2 


35—46 
34—45 
37—43 
33—44 


53—79 
57—76 
52—61 
52 68 







The cold waves, as seen above, are quite exceptional, 
the warm temperate flora of California extends north- 
ward as. far as the Rogue River; beyond that the summer 
becomes too cool, even in the interior, and the vegetation 
begins to resemble rather closely that of northern France 
and southern Britain, notably in the monotonous char- 
acter of the tree growth. We may note, 'in this connec- 
tion, that Portland and Seattle have almost exactly the 
temperatures observed in Paris and London, but shall 
see presently that this similarity does not extend to 
the other climatic factors in anything like the same 
degree. 

Alaska. The climate of southern Alaska resembles 
the preceding closely, save that it is a few degrees colder; 
as we go far westward, however, the summer becomes 
exceedingly raw and bleak, and the winter also becomes 
somewhat more severe, though still rather mild for the 
latitude. The following data are illustrative :' 





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53.9 


135.3 
166.5 


32 
30 


32 
29 


36 
30 


41 
33 


46 
38 


51 
44 


56 
50 


56 
51 


51 

47 


45 
42 


39 
36 


35 
32 


43.3 




38.5 







CLIMATOLOGY OF NORTH AMERICA 



101 



The reader will note the extreme retardation of the 
seasons on Unalaska, the best known of the Aleutian 
Islands; November is much warmer than April, and 
October almost equal to June. 

The rise of temperature on the Pacific Coast, from 
Sitka to San Diego, is 0.9 degree in January, 0.5 in 
July, and 0.8 for the year, for each degree of latitude. 
Between Edmonton and Yuma, in the Rocky Mountain 
Region, the corresponding figures are 2.3, 1.3, and 1.5; 
the still greater ones in the east have already been given. 
We observe, therefore, that the differences due to latitude 
diminish rapidly westward, being less than half as great 
on the Pacific Coast as on the Atlantic. 

Western Alaska interests us chiefly because of certain 
recent settlements along Bering Sea; the following 
approximate data for Port Clarence, near Nome, show 
that the climate is cold at all seasons : 





Lat. 


Lon. 


Winter 


Spring 


Summer 


Autumn 


Year 




65.1 


165.5 


-8 


16 


48 


24 


20.0 







Our data from the Yukon Valley are still scattered 
and scanty, but we have the following five-year record 
from Dawson City, just across the national boundary, 
which will give at least an approximation : 





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64.1 


139.3 


1200 


-21 


-12 


3 


29 


46 


58 


62 


56 


43 


23 


-3 


-13 


22.8 



The average extremes are 88 and— 56, the absolute 



102 THE CLIMATIC TREATMENT OF CHILDREN 

extremes 95 and— 68. The climate resembles that on 
the Saskatchewan, 1,200 miles to the southeast, but the 
winter is about ten degrees colder. The Yukon breaks 
up only about two weeks later than the St. Lawrence, 
but freezes a month earlier. 



GLOUDINESS AND HUMIDITY 

There are two recognized methods of calculating the 
percentage of clouds. One consists in judging the pro- 
portion of the sky that is covered, repeating this process 
at stated intervals during the day, and averaging the 
results. This method is apt to yield rather high percent- 
ages, because the apparent banking of clouds toward the 
horizon is included in the observer's estimate, and over- 
rated; in addition there is the element of the personal 
equation, which also has a tendency to overestimation. 
The second ; jglan consists in employing an automatic 
sunshine recorder of either the thermographic or photo- 
graphic type, and deducting the number of hours of 
sunshine observed from the total time between sunrise 
and sunset. The defect of this method is the ignoring 
of the night hours, which form the majority during half 
the year; this demerit is, however, not very important 
from the standpoint of medical climatology, which is 
not in any way interested in the ratio of cloudiness at 
night, but only in the actual proportion of sunshine. 
Throughout our territory, the first method gives a ratio 
of cloudiness from six to ten per cent, higher than the 
second; in our tables full details shall be given according 
fcrthe former, supplemented by the somewhat scantier, 
data afforded by the latter, in all cases by small districts, 



CLIMATOLOGY OF NORTH AMERICA 103 

so as to eliminate the personal equation as far as pos- 
sible. 

The relative humidity will be similarly stated, accord- 
ing to small districts. We have already explained that 
these figures, by themselves, are almost meaningless, and 
are really valuable only when referred to the tempera- 
ture prevailing at the time; it has therefore seemed 
worth while to go to the trouble of calculating the sensible 
temperature for the warm months at a large number of 
stations, in order to render this statistical material really 
useful. Under this sub-heading, the stations are thrown 
together into physiological groups, with reference to the 
indifferent temperature, and we believe that the tables 
will thus graphically show which places have, respec- 
tively, a hot, warm, cool or cold summer, in a way 
superior to anything of the kind hitherto published. In 
the more southerly districts similar data are given for 
the colder seasons; this feature is unnecessary where 
the thermometer averages below 55 or 60 degrees, as 
explained in the preceding chapter. 

Subarctic North America. Southern Greenland has a 
pretty uniform ratio of 65 to 70 per cent, of cloudiness 
throughout the year; Labrador more nearly resembles 
the arctic regions, having the lowest proportion, about 
55 per cent, in spring, and the highest, about 70 per cent, 
in autumn. In both regions the humidity is high; our 
data are very scanty, but 75 per cent, in the spring, and 
85 per cent, in the fall, will not be far from the truth. 
The distribution of fogs is quite strictly in accordance 
with the factors just mentioned. 

The Northeastern States and Canada. In this district 
the distribution of clouds is as follows : 



104 



THE CLIMATIC TREATMENT OF CHILDREN 



Newfoundland, Nova Scotia 

New Brunswick, Quebec 

New England, Middle Atlantic Coast 
Northern Alleghanies 



63% 
56% 
51% 
57% 



The coast is almost as clear in winter as in summer, 
August is the finest month northward, October south- 
ward. The inland districts are relatively very cloudy 
from November to March, a phenomenon as common as 
it seems paradoxical; in New York the cloudiness in 
December increases steadily from 55 per cent, on the 
coast to 85 on Lake Ontario; in summer these two sec- 
tions differ little, but the intervening mountains are 
about five per cent, cloudier. Along the coast, from 
New England to Virginia, we find an average of 2,620 
hours of sunshine annually (60%), whereas among the 
interior highlands the total diminishes to 2,190 hours 
(50%); these figures correspond quite closely to those 
for southern and northern Italy respectively. 

The distribution of the relative humidity is quite 
different in summer, though somewhat similar in winter, 
as follows : 





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77 


76 


79% 
73% 


Atlantic Plain 


74 


73 


70 


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71 


72 


73 


75 


77 


7o 


75 


74 


Northern Alleghanies .. 


79 


77 


76 


69 


71 


73 


75 


78 


79 


80 


80 


80 


76% 



The effect of the sea fog from May to September, of 
the cloudy conditions inland in winter, and of the 



CLIMATOLOGY OF NORTH AMERICA 



105 



mountain-valley fogs of autumn, is very apparent. The 
lowlands away, from the coast are relatively dry at all 
seasons, but especially in winter and spring. 

In regard to sensible temperatures, we need consider 
the warmest three months only, and group the localities 
as follows : 



Summer cold, 
Summer cool, 



54—56 
56—58 
58—60 
60—62 
62—64 
Summer warm, 64 — 66 
66—68 
68—70 
70—72 



52 — 54 deg., Father Point, St. John's. 



Yarmouth, Eastport. 

Chatham, Sydney, Rockliffe. 

Halifax, Charlottetown, Quebec, Northfield. 

Montreal, Ottawa, Portland. 

Boston, Nantucket, Block Island. 

Harrisburg, Albany, New Haven, Atlantic City. 

New York, Philadelphia. 

Baltimore, Washington, Lynchburg. 

Norfolk. 



The Lake Region. The distribution of cloudiness in 
the Lake Region is as follows : 



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Western New York 

Michigan, South Ontario, North Ohio. . 


78 
72 
58 


61% 
58% 

54% 







The cloudiest season everywhere is from November to 
January; the amount of cloud diminishes irregularly 
as we go west from Oswego, and falls off rapidly on the 
west shore of Lake Michigan, the east shore of which 
has almost as gloomy a winter as western New York; in 
fact, the relatively mildest stations have the most dis- 
agreeable weather. The finest weather is found in sum- 
mer at Chicago, which has only 40 per cent, of clouds 
from July to September; southern Michigan has 42. 

The general average of sunshine is 2,140 hours (47%), 
ranging from 2,440 at Chicago to 1,960 at Oswego; even 
the latter is higher than any record from England, 



106 



THE CLIMATIC TREATMENT OF CHILDREN 






northern France, or Germany, owing to the brightness 
of the summer months. 

The humidity is pretty uniformly distributed, but is 
a little higher northward. 





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Northern Lake Region. . 


83 


82 


79 


74 


72 


73 


73 


78% 


Southern Lake Region. . 


81 


81 


77 


71 


71 


72 


70 


72 


74 


74 


77 


79 


75% 



The winter is damper in the Lake Region than in the 
northeast, the summer is nearly the same, and fairly 
dry for the location. The sensible temperatures for the 
warmest three months are : 



Summer cold, 52 — 54 < 
Summer cool, 56 — 58 
58—60 
60—62 

62—64 



White River, Port Arthur. 

Marquette, Alpena, Saugeen, Duluth. 

Parry Sound, Toronto, Port Stanley, Kingston. 

Milwaukee, Grand Haven, Port Huron, Rochester, 

Buffalo, Oswego, Green Bay. 
Erie, Detroit, Chicago, Cleveland. 



The Ohio Valley. In this section the cloudiness and 
humidity are as follows : 





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71% 







The cloudiness is great for so continental a situation, 
higher than at many places farther north and east; 
there are 2,320 hours of sunshine (52%). 

The humidity in the summer months is the lowest 
east of Kansas; Cincinnati and Louisville having an 



CLIMATOLOGY OF NORTH AMERICA 



107 



annual average of only 68 per cent. All places in this 
region have a warm summer : 

66 — 68 deg., Indianapolis, Pittsburg, Columbus, Parkersburg, Cincinnati. 
68 — 70 " Louisville. 

The Upper South. The cloudiness in the upper South 
follows two types, on the eastern and western slopes of 
the Alleghanies respectively. 





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North Carolina to Georgia (uplands). . . 


57 
59 


54 
59 


48 
52 


45 

48 


46 
47 


51 

47 


52 
45 


53 

44 


44 
42 


38 

38 


44 
49 


50 
55 


48% 
49% 







The eastern slope has a relatively cloudy summer, 
whereas the west side of the Alleghanies and the Missis- 
sippi Valley are quite cloudy in winter, and have a 
bright summer; both sections have a very sunny Octo- 
ber. The proportion of sunshine in this region averages 
2,650 hours, 60 per cent, of the possible total. 

As regards humidity, the entire region is so uniform 
that but one statement will be required. 



Upper South. 



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72 


70 


65 


68 


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75 


77 


75 


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73 


74 



72% 



Only in northern Tennessee is the summer a trifle less 
moist than the winter, otherwise it is the dampest season 
of the year; the result appears in the very high sensible 
temperatures for the summer: 

Summer warm, 68 — 70 deg., Knoxville. 

70—72 " Raleigh, Charlotte, Nashville, Atlanta. 
72 — 74 " Memphis, Little Rock. 



108 



THE CLIMATIC TREATMENT OF CHILDREN 



At the last two stations the summer is almost trop- 
ical. 

In the South it is also worth while to give the sensible 
temperatures of spring and autumn, these being really 
the best seasons for visitors. I have taken April and 
October as the representative months for those seasons. 

April cool, 52 — 54 deg., Raleigh, Charlotte, Nashville. 
April mild, 54 — 56 " Atlanta, Memphis, Little Rock. 

The October temperatures are just four degrees higher 
throughout. 

The Lower South. In the lower South, we may also 
distinguish two types of cloudiness, the Atlantic States 
having a fine winter, and a moderately bright summer, 
whereas the Gulf States are quite cloudy in winter; both 
have a fine spring, and a wonderfully bright autumn. 



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North Carolina to Georgia (lowlands). . 


51 
56 


51 
55 


46 
47 


43 

46 


43 
43 


50 
49 


49 
51 


51 

48 


48 
43 


39 
36 


44 
44 


47 
52 


47% 
48% 







There are about 2,750 hours of sunshine, 62 per cent, 
of the possible total. 

The distribution of relative humidity varies chiefly 
according to the distance from the coast, but the summer 
is very moist at all stations, the chief difference being 
in spring and autumn. 





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80 
75 


80 
73 


78 
69 


76 
67 


77 
68 


80 
73 


81 

77 


83 
80 


81 

76 


79 
73 


80 
74 


80 
75 


80% 




73% 







CLIMATOLOGY OF NORTH AMERICA 109 

At Cape Hatteras the humidity ranges between 81 and 
84 per cent, throughout the year. 

The sensible temperature, in summer, is everywhere 
between 74 and 76 degrees, and therefore quite tropical. 
The spring (April) temperature is as follows: 

Mild, 54 — 56 deg., Augusta. 

56—58 " Wilmington. 

58 — 60 " Vicksburg, Montgomery, Charleston, Savannah. 

60 — 62 " Jacksonville, Mobile. 

62—64 " New Orleans. 

The autumn (October), on account of the greater 
humidity, has higher sensible temperatures than the 
spring, even where the dry thermometer ranges no 
higher. 

Mild, 58—60 deg. , Augusta. 

60 — 62 " Mobile, Montgomery, Vicksburg, Wilmington. 

62 — 64 " Charleston, Savannah. 
Warm, 64 — 66 " Jacksonville, Mobile. 

66—68 " New Orleans. 

In the eastern states, the usual duration of the uncom- 
fortably warm season is as follows, varying, of course, 
in different years : 

New York, Pittsburg, Omaha: June 15th to September 1st. 
Washington, Cincinnati, St. Louis: June 1st to September 15th. 
Raleigh, N. C, and Nashville: May 20th to September 25th. 
Charleston, Montgomery, and Vicksburg: May 10th to October 10th. 
Jacksonville and New Orleans: April 20th to October 20th. 
Middle Florida: April 1st to November 10th. 
South Florida: March 10th to December 1st. 

The best months for health-seekers and tourists are: 

New York, Pittsburg, Omaha: May, September and October. 
Raleigh and Nashville: April, October and November. 
Jacksonville and New Orleans: March, November and December. 
South Florida: the winter months. 

In the first three of these the last-named month is sub- 
ject to cold often sufficiently severe to make wraps and 
artificial heat necessary for comfort. 

Florida. The cloudiness and humidity are as follows 
in the Florida peninsula: 



110 



THE CLIMATIC TREATMENT OF CHILDREN 



Cloudiness 
Humidity. 



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81 


80 


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74 


76 


80 


79 


80 


82 


80 


80 


81 



47% 
79% 



The cloudiness closely follows the distribution of the 
rains; the finest season is in spring, just before the sum- 
mer deluge begins. Key West has 3,060 hours of 
sunshine, 68 per cent, of the possible total, and only 
about 55 cloudy days in the year; the figures for the 
peninsula proper are- nearly as favorable; there is a 
marked tendency in the rainy season to a clear sky in 
the daytime and clouds at night. 
The sensible temperatures are : 





Winter, 
Degrees 


Spring, 
Degrees 


Summer, 
Degrees 


Autumn, 
Degrees 




56 
61 
66 


66 
67 
70 


77 
76 

77 


69 




71 


Key West 


73 







The Mississippi Valley, etc. There are several types 
of cloud distribution in the Mississippi Valley, also 
westward and northward; we may form the following 
groups : 






Missouri, Illinois, Iowa 

Wisconsin, Minnesota 

East Kansas and Nebraska 
East Dakotas and Manitoba. 



54 52 

55 54 



49 49 49 
50 ! 51 51 

I I 



43 



49% 
52% 

44% 



CLIMATOLOGY OF NORTH AMERICA 



111 



In the Mississippi Valley the brightest season shifts 
from October to July, as we go northward, while De- 
cember is the cloudiest month throughout. Farther 
westward there are two clear and two relatively cloudy 
seasons, but they are unequal in degree. There is 
everywhere a tendency for the autumn to become less 
pleasant as we go north. The more southerly portions of 
this region represent that part of the continent where 
the Indian summer is most typically developed. 

The amount of sunshine varies between 2,600 and 
2,800 hours, 58 to 62 per cent, of the possible total. 

The relative humidity is distributed so uniformly 
through this region, that any division into subdistricts 
is difficult; we shall do best by throwing all our records 
together, as follows : 



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67 


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70 


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74 


78 


72% 



These figures are decidedly high for the center of a con- 
tinent; 62 per cent, in April and May, on the western 
edge of this region, is the lowest recorded. 

The sensible temperatures for the summer are as 
follows : 

Cool, 56 — 58 deg., Winnipeg. 

58—60 " Moorhead. 

60—62 " St. Paul, Huron. 

62—64 " La Crosse. 

Warm, 64 — 66 " Des Moines, Omaha. 

66—68 " Kansas City, Wichita. 

68—70 " St. Louis. 



70—72 



Cairo. 



The South Central States. In the South Central States 
the distribution of cloudiness is as follows : 



112 



THE CLIMATIC TREATMENT OF CHILDREN 





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48 


38 
43 


36 
38 


35 

42 


33 
43 


30 
37 


39 
46 


45 
51 


40% 


East and South Texas 


47% 



Note the suggestion of a July drought in Texas, as 
shown by the low percentage of clouds; and the clearness 
of October throughout. 

The amount of sunshine ranges from 2,800 hours on 
the coast of Texas to 3,100 in Oklahoma (62 to 69%). 

The humidity is excessively high on the coast, but 
moderate even a short distance inland. 





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84 
73 


84 
71 


83 
68 


83 
68 


81 

72 


81 
73 


79 

71 


80 
71 


79 

71 


77 
69 


81 
71 


82 
71 


81% 




71% 







The sensible temperatures are as follows : 

Summer warm, 68 — 70 deg., Oklahoma. 

Summer hot, 74 — 76 " Shreveport, San Antonio. 

76 — 78 " Galveston, Corpus Christi. 



Spring (April) mild, 54—56 
58—60 
62—64 

Spring warm, 64 — 66 



Oklahoma. 

Shreveport. 

San Antonio. 

Galveston, Corpus Christi. 



The fall ranges about two degrees higher than the 
spring. 

Over the whole area so far discussed the climate is 
either moist or of medium humidity, never dry; the 
lowest monthly humidity, even in spring, has in no case 
fallen under 62 per cent., and we have met with this as 
far east as Cincinnati and even Baltimore. The lowest 



CLIMATOLOGY OF NORTH AMERICA 



113 



proportion of clouds has been about 40 per cent, for 
the year, in Kansas and Oklahoma, but this figure, also, 
is not much below some records on the Atlantic Coast, 
where 46 per cent, is noted at several stations. 

West of the 98th meridian, we encounter a great 
and rapid change, and we find a very different state of 
things on. 

The Great Plains. The ratio of clouds is not so very 
greatly diminished on the Great Plains, which we may 
subdivide in the same manner as we did in discussing 
the temperature. 



Colorado and Western Kansas. . . 
Wyoming and Western Nebraska 
Montana and Western Dakotas . . 
Saskatchewan and Alberta 



39 39 37 39 38 38 41 36 29 34 36 36% 

40 45|48 51 140 43 40 33 35 i 36 40 41% 
52 53'54 53 52 40 37 41 48 49 51 48% 
56 57 5553 56 44 40 48 54 54 55 52% 



These figures are only a few per cent, lower than in 
the well-watered region eastward. On the middle slope, 
the cloudiness follows the rainfall closely; this is not 
the case farther south or north; in the former direction 
the rainy season is unduly clear, and in the latter the 
almost rainless winter is quite cloudy and, as we shall 
see, also damp. 

The amount of sunshine is, indeed, large, but not 
phenomenal for so dry a region, ranging from 2,700 
hours (60%) on the upper Missouri to 3,200 (71%) at 
Denver; thus Colorado is not far ahead of Kansas and 
Oklahoma in this respect; still, Denver has 190 clear 
and only 55 cloudy days in the year, whereas New York 
City has about 130 of each. 



114 



THE CLIMATIC TREATMENT OF CHILDREN 



The humidity, in general, decreases with the altitude, 
that is, with the proximity to the mountains. There is, 
however, a considerable difference according to lati- 
tude, the dividing line being at about the 42d parallel, 
north of which the winters are as damp as in the eastern 
states, while the summers are dry. Our records are: 



Western Kansas and Nebraska 

Western Dakotas 

Texas Panhandle to Black Hills 

Colorado and Wyoming 

Montana 



65% 

68% 
59% 
50% 
57% 



The most remarkable feature of this table is the May 
humidity of 52 per cent, at Denver, in association with 
abundant rains. The sensible temperatures for the 
summer are, as will be seen, exceedingly low in com- 
parison with the readings of the ordinary thermometer 
previously given. 

Cold, 50 — 52 deg., Edmonton, Prince Albert. 

52 — 54 " Lander, Helena. 

Cool, 54 — 56 " Regina, Medicine Hat, Cheyenne, Havre. 

56—58 " Williston, Rapid City, Denver. 

58—60 " Bismarck. 

60—62 " Pierre, North Platte. 

Warm, 64— 66 " Amarillo. 

66—68 " Dodge City. 

70—72 " Abilene. 

The Western Plateau, Here we encounter- an ap- 
proach to absolute clearness for the first time, the pro- 
portion of clouds for the summer and early autumn 
becoming very low indeed. The figures for the winter 
are fairly high even in the Great Basin, and become 
very high northward, so that the wet season in those 
parts becomes quite gloomy, recalling the least favored 



CLIMATOLOGY OF NORTH AMERICA 



115 



portions of the eastern states, without attaining the 
high percentages of certain parts of the Lake Region. 





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20 

26 


22 

21 


25 
34 


32 
47 


36 
54 


51 

67 


37% 


Idaho, East Oregon and Washington . . 


49% 



The amount of sunshine declines from 3,000 hours 
(67%) in Utah and Nevada to 2,600 (58%) in eastern 
Washington. 

The distribution of the relative humidity is similar, 
the winter being moderately moist, the summer exceed- 
ingly dry and even desert-like. 





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Utah and Nevada 


70 


64 


55 


45 


46 


38 


32 


33 


38 


48 


58 


70 


50% 


Idaho, East Oregon and Washington . . 


79 


74 


66 


56 


56 


5, 


41 


42 


51 


62 


74 


79 


61% 



The resemblance of this region to Central Asia is remark- 
able ; the vegetation of the two regions is also very 
similar, presenting many types that are uncommon in 
other portions of the globe. 

The sensible temperatures of the summer are ex- 
tremely low; the difference between shaded and sunny 
situations is enormous; the former are unfortunately 
hardly obtainable except in the towns, for, southward at 
least, the country is almost bare of trees, though there 
are fine forests in the northern parts. The figures are: 

52 — 54 deg., Carson, Winnemucca, Baker City. 
54 — 56 " Spokane. 
56—58 " Boise City, Salt Lake City. 
58—60 " Walla Walla. 



116 



THE CLIMATIC TREATMENT OF CHILDREN 



The Southwest. The proportion of clouds in the South- 
west is very small, with minima in spring* and autumn, 
and maxima in winter and midsummer. Toward the 
east the midsummer maximum leads, in the desert the 
winter maximum, but in the latter this ■" cloudy" 
season is clearer than any month east of the Missouri 
River. 





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Western Texas and New Mexico. ...... 


32 
31 

27 


35 
32 
29 


34 
30 
29 


31 
23 

22 


32 
18 
19 


32 
17 
11 


41 

42 
16 


42 
41 
20 


34 
21 
14 


26 
18 
17 


33% 

27% 




21% 





Santa Fe has 3,400 hours of sunshine (76%), Phoenix 
3,730 hours (83%), Yuma about 4,000 hours (89%). 
Yuma has 308 clear and only 12 cloudy days in the 
year, and is probably not surpassed in this respect by 
any spot on the globe. 

The humidity is generally lowest in spring, but very 
low at all seasons. 





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West Texas to Arizona. . . 


51 


47 


37 


30 


29 


27 


43 


45 


44 


44 


45 


47 


41% 

35% 


Southeastern California . . 


48 


39 


35 


30 


30 


27 


30 


35 


32 


37 


39 


44 



In Death Valley the average for the summer is 20 per 
cent., and for the year barely 30 per cent., rivaling 
the interior of the Sahara. 

The sensible temperatures are relatively very low, 
but here we note the inadequacy of this method of 



CLIMATOLOGY OF NORTH AMERICA 



117 



recording our perception of heat in the desert. As a 
matter of fact, the fearful noon heat in the lowlands, 
with the sun almost vertical, is quite unendurable. 

Summer cool, 52 — 54 deg., Santa Fe\ 

54 — 56 " Independence. 

Summer warm, 64 — 66 ' ' El Paso. 
68—70 " Phoenix. 
72—74 " Yuma. 

At Yuma, the summer is almost tropical in its sensible 
temperature, in spite of the very great dryness; it is 
therefore ridiculous to say that the heat is not felt; at 
best, in the shade, it feels almost as hot as on the South 
Atlantic Coast; in the sun it is an inferno. 

The Pacific Coast. In reviewing the ratio of cloudiness 
on the Pacific Coast, we must bear in mind the four 
main factors that determine it. They are: first, the 
tendency to increase northward; secondly, the summer 
drought in the interior; thirdly, the summer sea fogs 
on the coast; fourthly, the tendency in winter to 
clearer weather on the coast than inland. In the 
following table the relation of these elements is 
evident : 





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South California Coast . . . 


38 


40 


43 


46 


50 


44 


42 


39 


34 


35 


31 


39 


40% 

47% 


Middle California Coast . . 


51 


49 


51 


52 


51 


44 


47 


45 


40 


41 


39 


49 


North California Coast . . . 


64 


64 


66 


66 


64 


60 


56 


52 


52 


53 


56 


65 


60% 
64% 


Oregon Coast 


70 


68 69 


67 


65 


6tt 


59 


54 


58 


59 


65 


71 


Washington Coast 


76 


73 1 72 


69 


66 


64 


62 


56 


64 


66 


74 


78 


68% 



The northwest coast has the gloomiest climate in North 
America; the ratio of clouds continues to increase north- 
westward, reaching 82 per cent, on Unalaska Island. 
Inland the figures are : 



118 



THE CLIMATIC TREATMENT OF CHILDREN 



Great Valley of California 

Western Oregon, interior 

Western Washington, interior 



29% 
55% 
61% 



The clearness of the summer of interior California is so 
great as to be monotonous, and it is considerable even 
on Puget Sound. In winter there is a rapid transition 
from the very bright weather of southern and central 
California to the gloomy conditions northward; the 
change takes place rather suddenly, at about the 40th 
parallel, both on the coast and inland. In summer the 
increase northward is gradual everywhere, but the sky 
clears abruptly on crossing the Coast Range eastward. 

Tatoosh Island has only 1,560 hours (35%) of sun- 
shine, Seattle and Portland have 1,980 hours (44%), 
Eureka has 2,070 hours (46%), the southwest coast 
3,200 (71%), and the Great Valley 3,400 (76%). 

On the coast itself the humidity steadily rises from 
moderate proportions in the south to extraordinarily 
high figures northward, the summer or autumn being the 
dampest season. In the interior the winter is moist, and 
the summer is very dry in the south and moderately so 
northward. The following table will show this more fully ; 





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South California Coast... . 


69 


69 


72 


72 


75 


75 


75 


76 


73 


74 


68 


65 


72% 


Middle California Coast . . 


80 


78 


78 


78 


79 


80 


84 


86 


81 


79 


77 


80 


80% 


North California Coast . . . 


86 


85 


84 


86 


86 


86 


88 


90 


89 


89 


87 


85 


87% 


Oregon Coast 


88 


87 


87 


88 


89 


88 


89 


90 


91 


92 


90 


88 


89% 
92% 


Washington Coast 


90 


89 


90 


91 


92 


91 


91 


92 


93 


94 


94 


92 



CLIMATOLOGY OF NORTH AMERICA 



119 



The dampest month gradually shifts from August to 
October. The figures inland are : 



Great Valley (except Sacramento) . 

Sacramento 

West Oregon, interior 

West Washington, interior 



.a 

a 
51 






Z Q 



80 7066 58 53 41 33 35 42 54 65 81 57% 
80:73 70 65 66 59 58 58 57 62 69 81 66% 
85 81 75 70 69 68 63 65 70 : 79 84 87:74% 

84 79 75 71 71 70 67171 176181 184|84 76% 



The relative dampness of Sacramento in summer is due 
to the same cause as the only moderately high tempera- 
ture, namely, a slight remnant of the sea breeze blowing 
in through the Golden Gate; this place is, however, no 
cloudier than the other interior points, the sea fog does 
not penetrate nearly so far, 

The sensible temperatures range as follows; they are 
quite low at the inland stations, but the remarks made 
in reference to the near-by deserts apply here equally 
well. As the spring and later autumn are pleasantly 
cool everywhere, we shall consider the summer data 
only. 

■52 — 54 deg., Victoria. 

54 — 56 " Tatoosh Island, Eureka, Seattle. 

56 — 58 " Portland, Roseburg, San Francisco. 

62 — 64 " Fresno, Red Bluff, Sacramento, Los Angeles, San Diego. 

We may close this division of our subject with the fol- 
lowing brief summary: In winter there are maxima of 
cloudiness in the far Northwest and the Lake Region, 
both exceeding 80 per cent. ; there is a minimum of 42 
per cent, at Key West, and one of 24 at Yuma. In 
summer the farthest Northwest and Northeast have 
each about 60 per cent., whereas we find 32 per cent, 
in Oklahoma, and less than 10 per cent, in Central 



120 THE CLIMATIC TREATMENT OF CHILDREN 

California. For the year, we have over 70 per cent, on 
the Alaskan Coast, and only 18 per cent, at Yuma. 

The winter maxima of humidity are 82 per cent, over 
the upper Lake Region and the Texas Coast, and 90 in 
the far Northwest; the two latter persist in summer, but 
the first shifts to the islands off the Atlantic Coast. The 
eastern minima are 74 per cent, in the Atlantic Plain in 
winter and 66 per cent, in the Ohio and Missouri Valleys 
in summer; westward the lowest figures are reached on 
the southeastern slope of the Rocky Mountains and in 
the southwestern deserts. 

The average amount of sunshine is 2,600 hours in the 
eastern half of the United States, and 2,950 in the west, 
the absolute extremes being attained at Tatoosh Island 
and Yuma, respectively. 

PRECIPITATION 

The Gulf of Mexico is the chief source of moisture for 
eastern North America. During the colder months, the 
southwest winds in the southern quadrant of the trans- 
continental storms bring abundant moisture to the terri- 
tory lying east of a line running from the mouth of 
the Rio Grande to Lake Michigan. In summer, the well- 
defined storms are less important, but the barometric 
depression in the Southwest causes a steady indraught of 
warm and moist southeast winds; the rains are therefore 
carried northwestward as far as the Continental Divide. 

East of the Alleghanies, there is an additional supply 
of moisture from the Atlantic Ocean, brought to the 
land by northeast winds; this source of rain is, however, 
subordinate to the preceding, except in the upper Lake 



CLIMATOLOGY OF NOKTH AMERICA 121 

Region and from there to the northeast coast. These 
rains are of most account in the autumn and winter. 

In the subarctic regions we have the minimum in 
spring and the maximum in fall; that is common to 
almost all far northern localities. 

The entire East may therefore be subdivided as follows : 

I. The subarctic regions; precipitation as above. 

II. The Northeast, including the : Lake Region; a 
fairly even distribution throughout the year, with a tend- 
ency to an autumn maximum far northward, a winter 
maximum far eastward, and summer maximum inland 
and toward the south. 

III. The Southeast; summer rains everywhere, winter 
rains in the mountains, but a dry winter on the Atlantic 
Coast and in Florida. 

IV. The Mississippi Valley and the Great Plains; sum- 
mer wet, winter moderately dry in the south, very dry 
in the north. 

The Pacific side of the continent depends chiefly on 
the Ocean for its moisture, a little comes to the far 
Southwest from the Gulf of California. The rains follow 
the common rule of falling only when the land is cooler 
than the sea, and the cool months are therefore the 
wettest. The total falls off rapidly as we go south from 
Puget Sound, and southward the summer becomes 
absolutely rainless. The arid Southwest gets practically 
no rain, except in summer in # the uplands, where warm 
Southwest winds from the Gulf of California deposit 
some moisture in ascending; this rainy season is a mere 
remnant of the tropical rains of Mexico, and limited to 
the hottest months. 



122 THE CLIMATIC TREATMENT OF CHILDREN 

We may therefore divide the western region as follows : 

V. The Western Plateau (north of latitude 37°) ; some 
rain in winter and spring, very little in summer and 
autumn. 

VI. The Southwest; rain in midsummer in the moun- 
tains, otherwise perennial drought. 

VII. The Pacific Coast; similar to district V, but 
wetter in winter and drier in summer, with an extreme 
difference between the north and south. 

Our tables will embrace only long records, which have 
been grouped according to states and districts, both to 
compensate for local errors, and because precipitation is 
more a regional than a local phenomenon. Owing to 
large annual variations, data of rainfall cannot pretend 
to the accuracy of those given for temperature or humid- 
ity; the probable error in the annual means for even 
twenty-five years varies from two per cent, on the 
Atlantic Coast to more than five on the Pacific, and is 
over three times as great as this for the monthly 
means. 

It is also important for us to know the number of wet 
days, the amount and frequency of snow, and the rain 
intensity. The number of days with thunderstorms is 
also useful. All these matters, with other serviceable 
data, will be referred to frequently as we go on. 

I. Subarctic North America.- Southern Greenland and 
the coast of Labrador are so much alike that they may 
be thrown together; they agree with the other subarctic 
climates throughout the world in having the heaviest 
precipitation from July to October. 



CLIMATOLOGY OF NORTH AMERICA 



123 



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1.6 


1.6 


1.8 


1.6 


'2.1 


2.4 


3.0 


3.5 


1 

4.0 I 3.0 


2.2 


1.6 


28.4 



There are 160 to 200 wet days, about half of them with 
snow, which, may fall even in midsummer, and attains 
a total depth of ten to fifteen feet. Owing to the cold- 
ness of the summer, thunderstorms are quite uncommon. 



II. The Northeastern States and Eastern Canada. As 
before stated, this extensive region is notable for a cer- 
tain uniformity in precipitation; we may, however, 
recognize a number of subdivisions, which present mod- 
erate differences. 

In the farthest Northeast nearly all the months are 
quite wet, but there is a decided excess in the six months 
from October to April; June and September are regularly 
a trifle drier than the others. 



Newfoundland, Nova 
Scotia, E. New Engl'd . 



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4.6 


4.2 


4.4 


3.4 


3.8 


3.4 


3.8 


3.8 


2.8 


4.8 


4.6 


4.4 



48.0 



Immediately to the west of this district the summer is 
somewhat in excess, but the winter remains very moist. 





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3.43.0 


3.4 


2.6 


3.2 


3.24.24.0 


3.2 


3.2 


3.4 


3.2 


40.0 


New Jersey ) ■ 










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124 



THE CLIMATIC TREATMENT OF CHILDREN 



' In the Lake Region the autumn months lead in the 
north and east, and the summer months in the south and 
west; early spring is dry everywhere, and the winter 
also, except eastward. 





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E. Lake Region 


2.9 


2.7 


2.7 


2.1 


2.9 


3.0 


3.0 


2.6 


3.1 


3.3 


3.5 


3.2 


35.0 


N. Lake Region 

S.W.Lake Region 


2.0 


1.6 


1.8 


1.6 


2.6 


2.8 


3.0 


2.8 


3.8 


3.2 


2.6 


2.2 


30.0 


2.0 


2.1 


2.2 


2.4 


3.5 


3.8 


3.2 


3.0 


3.2 


2.8 


2.6 


2.2 


33.0 



The greater part of the Middle Atlantic States and the 
Ohio Valley have maxima in summer and winter, and a 
minimum either in spring or autumn, but moderate in 
either case. 



S. New York, Pennsyl 
vania, Maryland, Vir- 
ginia, W. Virginia, 
Ohio, Indiana 



ia, l" 





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3.4 


3.4 


3.4 


3.2 


3.8 


4.0 


4.0 


3.8 


3.2 


2.8 


3.0 


3.0 



;*£ 



41.0 



The tables given will render the detailing of minor 
variations superfluous. The number of wet days ranges 
from 120 on the Middle Atlantic Coast, the Ohio River 
and the southern tip of Lake Michigan to 160 in the 
extreme Northeast and 170 in the northern and eastern 
Lake Region. Snow falls on 10 to 20 days in Virginia, 
20 to 30 from Long Island to Indiana, but as many as 
40 to 60 in the northern Alleghanies and 80 to 90 in the 
northern sections that have a wet winter. The number 
of thunderstorms gradually increases from ten per annum 
in the far Northeast to forty in Virginia and Ohio. The 



CLIMATOLOGY OF NORTH AMERICA 125 

depth of snow, only about a foot for the entire season 
in southern Virginia, increases rapidly northward to a 
maximum of ten or twelve feet in the St. Lawrence 
Valley and certain localities in the Lake Region; few 
points north of the 42d parallel have less than four or 
five feet in all. 

In the Lake Region, we invariably find the heavier 
snowfall on the milder shore, the northwest winds are 
warmed on crossing the lakes and become loaded with 
moisture, which is promptly condensed on reaching the 
cold bank opposite; the remarkable phenomenon is then 
presented of a heavy precipitation with a rising barom- 
eter on the lee side of the lake, while the windward 
shore enjoys fine and cold weather. In summer, these 
differences almost disappear, owing to the more uniform 
barometric and thermometric conditions ; they are also 
far less marked in mild than in severe winters; in the 
latter the climate of such places as Oswego, Buffalo and 
Grand Haven is exceedingly disagreeable, though not 
nearly so cold as at the stations across the respective 
sheets of water, "it must be remembered that the 
Great Lakes do not freeze over even in the severest 
seasons. 

The duration of the snowy season naturally varies 
widely according to the latitude. In the coldest sec- 
tions, only July and August are free from snow, which 
falls frequently in late September and not so very 
exceptionally in early June; the ground is permanently 
covered from November until April in ordinary years, 
and the usual depth on the first of March is from three 
to five feet on the level. Along the southern border 
of this region, from Cape Cod to Cincinnati, snow is 



126 



THE CLIMATIC TREATMENT OF CHILDREN 



uncommon in October, and very rare indeed in May 
except in New England; the ground is rarely covered 
continuously for more than a month, and may be bare 
for weeks at a time in the dead of winter, as in 1906. 

III. The Southeast. This region is decidedly more 
heterogeneous than the preceding, and requires consider- 
able subdivision. 

In the Cape Hatteras region and on the Bermudas all 
the months are wet, but the late summer and early 
autumn lead. 



Hatteras . . 
Bermudas . 



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5.9 


4.5 


6.1 


4.7 


4.6 


4.6 


6.4 


6.4 


6.4 


6.2 


5.2 


5.5 


4.8 


4.4 


5.6 


4.5 


4.8 


5.9 


4.6 


6.1 


5.5 


8.3 


4.2 


4.3 



.5 

63.2 



On the South Atlantic Coast and in Florida, also in 
southern Texas, we have the dry and cool and wet 
and warm seasons of the West Indies and Central 
America. 





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Lowlands of N. O., S. 0„ 

Ga., and Florida 

South Texas 


3.8 
1.9 


3.2 
1.7 


3.8 
1.5 


■3.4 
1.8 


4.2 
3.0 


5.6 

2.7 


6.2 
1.8 


6.8 
3.3 


6.8 
4.8 


5.0 
2.0 


3.0 
2.0 


3.2 

1.5 


55.0 
28.0 



A peculiar feature is the midsummer drought that 
appears at Galveston and becomes extreme in southern- 
most Texas. 

In the southern Alleghanies, along the lower Mississippi 
and on the middle Gulf coast there is more rain in winter; 
October is quite dry everywhere. 



CLIMATOLOGY OF NORTH AMERICA 



127 



South Alleghanies . . 
Middle Gulf Coast . . 
Lower Mississippi Valley.. 



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4.8 


4.6 


5.2 


4.0 


3.8 


4.2 


4.6 


4.6 


3.4 


2.8 


3.2 


3.8 


4 6 


4 


4.4 


4.0 


4.2 


5.6 


5.4 


6.4 


5.6 


3.6 


4.0 


4.2 


4.8 


4.6 


5.0 


5.0 


4.8 


4.2 


3.6 


3.2 


3.2 


2.8 


4.6 


4.2 



49.0 
56.0 
50.0 



A few explanatory remarks are indispensable. The 
October maximum of Bermuda also occurs at Jupi- 
ter, Fla., and affects the figures for Hatteras, as we 
have seen; the cause of this peculiarity, which these 
points share with the more easterly Antilles, lies in the 
course of the autumn hurricanes along the Gulf Stream, 
near all these stations. In the southern Alleghanies we 
find the rare phenomenon of a maximum precipitation 
in winter far inland; this peculiarity also affects their 
western foothills as far as Nashville and Montgomeiy, 
and is due to the condensation of warm and moist south- 
west winds from the Gulf of Mexico. Southern Texas, 
as noted, has a very dry winter and suffers from severe 
drought in midsummer, so that this section becomes 
almost desert-like in July. The Atlantic Coast from 
Cape Fear southward, including the whole Florida pen- 
insula has a distribution of rainfall precisely like that of 
the West Indies; the year consists of well-marked dry 
and rainy seasons, the former from October or November 
to May, the latter embracing variously four to six months; 
thus visitors to this section are sure of much fine weather 
at the very season when the upper South, especially 
among the hills, is almost drowned in torrential rains, 
with occasional snow. It will be noted that the summer 
is wet almost everywhere ; this circumstance, in com- 
bination with the high temperature and humidity noted 



128 THE CLIMATIC .TREATMENT OF CHILDREN 

in previous paragraphs, fully accounts for the insalubri- 
ous character of the four warmest months south of the 
37th or 38th parallel. 

The remaining peculiarities of the southeast require 
but cursory mention. Glancing at this region as a 
whole, we note three centers of especially heavy pre- 
cipitation, each exceeding sixty inches per annum, sit- 
uated respectively in the highest Alleghanies, on the 
middle Gulf coast, and near the Gulf Stream. We have 
no good records for the first of these, but the others are 
well displayed in the preceding tables; Jupiter, Fla.,also, 
has a total of 58 inches, 19 of which are equally divided 
between September and October. 

The number of rainy days is almost everywhere in the 
ratio of one to each 0.45 inch of rain, being 100 at Key 
West, 150 at Bermuda, 120 to 130 at almost all other 
stations east of the Mississippi, 100 to 110 west thereof 
as far as Galveston and Palestine, Tex., 80 at San An- 
tonio and Corpus Christi, and only 50 to 60 on the lower 
Rio Grande. The amount for each rainy day is thus 
seen to be very great, and so-called cloudbursts are 
rather frequent throughout the South. A precipitation 
of two inches within an hour is common in many parts 
of the United States, and three inches in an hour have 
been recorded at places so far apart as Rio Grande City, 
Jacksonville, Philadelphia and Dodge City, Kan. A 
fall of ten inches in twenty-four hours is not very un- 
common in the South, but rare in the North, where even 
six inches in a day are quite infrequent. 

Snow is common in the southern states only in the 
Alleghanies and Kentucky, where about two feet fall 
on fifteen days; in Arkansas, western Tennessee, and 



CLIMATOLOGY OF NORTH AMERICA 129 

the Cape Henry district some six to twelve inches fall 
on about seven days; at Wilmington, Montgomery and 
Vicksburg an inch or two on a day or two. In the 
extreme South snow falls about once in two years, and 
lies on the ground about once in a decade, and in the 
Florida Peninsula snow is a very great rarity, though a 
few flakes have been observed as far south as Punta 
Rasa; the same is true of the Bermudas. 

Thunderstorms average 40 to 70 per year, the latter 
in Florida, where they are common at all seasons, except 
the latter part of autumn. Tornadoes are quite frequent 
and destructive in the lower Mississippi Valley, less so 
east of the Alleghanies; southward they are commonest 
from February to May, northward from April to June; 
the weather is too steady for their development in mid- 
summer and thereafter. 

IV. The Central States. Northwest of a line drawn 
from Indianapolis to San Antonio, Texas, from Lake 
Michigan to the crest of the Rocky Mountains, we have 
a wonderfully uniform and typically continental dis- 
tribution of precipitation. The maximum regularly falls 
in June— occasionally May or July — and the period from 
October to March is relatively very dry. Careful study 
shows that this region is saved from absolute drought 
only by the great southwestern depression and the 
resulting southeast winds, both of which conditions are 
prevalent only from April -to August or September; 
extension of the depression toward the Mississippi, as in 
July, 1901, causes a shifting of the winds to southwest 
with serious drought far eastward. 

Owing to the mentioned remarkable uniformity of 
precipitation, one table will suffice for nearly the entire 



130 



THE CLIMATIC TREATMENT OF CHILDREN 



central region. It is of interest to note a gradual decline 
from south to north, especially in the winter months, 
and a falling off' from east to west, also most marked in 
the colder season. In eastern Nebraska only 8 per cent, 
of the total falls in winter, but 43 per cent, from May 
to July. 





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Upper Mississippi Valley . 
Plains, East 


1.4 
1.0 

0.8 
0.4 
0.6 


1.6 
1.2 
0.8 
0.6 
0.8 


2.0 

1.8 
1.0 
0.8 
0.8 


2.8 
3.0 
1.8 
1.6 
0.8 


4.0 

4.2 
2.6 
2.2 
1.8 


4.6 
4.2 
3.4 
2.0 
3.0 


3.e 

3.6 
2.4 
1.6 
2.6 


3.2 
3.0 
2.0 
1.4 
2.2 


3.0 
2.6 
1.4 
0.8 
1.4 


2.4 
1.8 
1.2 
0.8 
0.8 


1.8 
1.4 
0.8 
0.4 
0.6 


1.6 
1.2 
0.8 
0.4 
0.6 


32.0 
29.0 
19 


Rocky Mts., East. Slope. . 
N.W.Canada 


13.0 
16.0 



In western Montana the type is somewhat mixed, 
Helena has a little more precipitation in winter, coming 
from the Pacific Ocean across the watershed,* which is 
somewhat lower in Montana than farther south; this is 
shown by the following data : 



Helena. 



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0.8 


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1.6 


2.4 


1.1 


0.6 


1.2 


0.9 


0.7 


0.9 



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13.4 



In the above extensive region it will be noted that, 
toward the south and west, there is a tendency for the 
maximum precipitation to occur in May, while north- 
westward there is a tendency to a July maximum. The 
decrease westward is very marked, occurring rather 
abruptly in the 200-mile strip between the 96th and 
100th meridians. This belt does not, however, repre- 
sent a constant dividing line, but an area of uncertain 



CLIMATOLOGY OF NORTH AMERICA 131 

rains, being dry in one year and moist in another; 
farther east drought is exceptional, occurring possibly 
once in a decade, farther west it is common, indeed 
almost certain, so that the farmer learns to depend 
chiefly on irrigation. 

Among minor matters we may note a tendency to 
autumn rains in the Upper Mississippi Valley, coming 
from the upper Great Lakes, and associated with the 
rainiest season in that section; also, on the southern 
slope, a small proportion of the late summer rains of the 
southwestern Rocky Mountain Region. Neither of these 
features, however, obscures the general type to any 
marked degree. 

The number of wet days ranges from 120 along the 
middle Mississippi River to 65 in Wyoming and Colorado ; 
it snows on 10 days in Oklahoma, 30 to 40 in Colorado 
and Wyoming, and 40 to 50 in the north, the total 
depth of snow ranging similarly from one to six feet. 
The Great Plains have much less snow than the north- 
eastern mountains and the Lake Region, contrary to the 
popular belief; the ground is sometimes bare in January 
and February almost tp the international boundary, for 
the heavy blizzards and general snowstorms occur only 
at long intervals, and are commoner in autumn and early 
spring than in midwinter. 

Thunderstorms are common everywhere, occurring 
on 20 days annually in the northwest and 50 days in the 
southeast of this territory. The eastern and southern 
portions of this region are peculiarly subject to the most 
destructive kind of tornadoes; these whirlwinds seem to 
.be especially frequent in Missouri and eastern Kansas, 
but rare north of South Dakota and west of the 100th 



132 



THE CLIMATIC TREATMENT OF CHILDREN 



meridian. The occurrence of hot winds has been dealt 
with sufficiently on page 87. 

V. The Western Plateau. Here the type of precipita- 
tion is almost exactly the opposite of that described 
above in discussing the eastern slope. Strictly speaking, 
however, this is true only between the 37th and 49th 
parallels; the section farther south will be dealt with 
separately, that farther north has a distribution of 
moisture resembling that of the Atlantic states. 

In the Great Basin and Idaho intense drought pre- 
vails from July to September, reducing the country to the 
condition of an absolute desert, except along the few 
water courses; the spring is a little moister than the 
winter in the east of the plateau, and drier in the west, 
where the conditions on the Pacific Coast are much in 
evidence; the differences are, however, so slight that 
one table will suffice: 



3 

1-3 


>> 

c3 
g 

-8 


o 
S3 


a 
< 




e 

a 

3 

1-3 


>> 


1 

< 


u 

% 

.0 

S 
a 
o> 

CO 



O 


u 

V 

Xi 

B 



u 

B 
8 


00 


2.0 


1.5 


1.6 


1.4 


1.4 


1.2 


0:4 


0.4 


0.6 


1.0 


1.4 


2.0 


15.0 



These figures comprise a minimum annual precipitation 
of 9 inches in central Nevada and a maximum of 18 on 
the upper Columbia River; the number of wet days is 60 
in the former district and 120 in the latter, so that only 
about 0.15 inch falls on each day; apart from the rare 
cloudbursts, the precipitation consists chiefly of light 
drizzles and mere flurries of snow. 

The number of days with snow varies similarly from 
25 to 50 per year, the relatively large number being due 



CLIMATOLOGY OF NORTH AMERICA 133 

to the wet period occurring in winter; the depth of snow 
is from 2 to 4 feet. Thunderstorms are uncommon, 
because the summer is too dry; they number from 4 to 
12 per annum. 

In interior British Columbia the type is evidently 
mixed, but our records are still short, and embrace but 
few stations. The total rises from 12 inches in the river 
valleys to 30 and more in the mountains; one- third falls 
in summer and about a fourth each -in autumn and 
winter, the spring being relatively dry; the conditions 
thus resemble those in the North Atlantic States. The 
winter snows in the British Rocky Mountains attain a 
depth of 15 feet, exceeded only in the California Sierra. 

VI. The Southwest. The rain-shed between the Gulfs 
of Mexico and California does not correspond to the sur- 
face drainage, but lies on the crest of the Guadalupe 
Mountain range, west of the Pecos River. The dividing 
line is not very sharp, because moisture seems to cross 
over, at times', in either direction, and because the wet 
and dry seasons are nearly the same on both sides; the 
July drought is, however, characteristic of the eastern 
slope, and absent in the west. 

In western Texas and in New Mexico more than half 
of the total precipitation is crowded into July,. August 
and September, with an evenly distributed and very light 
rainfall during the remainder of the year. In Arizona 
there is a little rain in winter, coming from the Pacific 
Ocean, but April, May and June are almost rainless. 
The totals, exceeding *20 inches in parts of the mountains, 
fall below 10 at El Paso and 7 at Phoenix, where the 
truly desert conditions of the southwestern lowlands 
become manifest. I give the following table: 



134 



THE CLIMATIC TREATMENT OF CHILDREN 



W. Texas and New Mex... 
Arizona 



>, 


>> 
u 














u 




u 






2 


o 


a 
<3 


>> 


a 

»-9 


*-9 


1 


fa 
S 

a 


JO 

o 
« 
O 


> 

o 




0.6 


0.6 


0.6 


0.6 


1.0 


1.2 


2.8 


3.0 


2.0 


1.2 


0.6 


0.8 


1.2 


1.2 


1.2 


0.6 


0.4 


0.4 


2.8 


2.8 


1.4 


0.8 


0.8 


1.4 



it 



15.0 
15.0 



In northern Mexico the rains arrive a month earlier 
and are more abundant ; Chihuahua has about 25 inches, 
three-fourths of which fall from June to August; in the 
city of Mexico 70 per cent, of the total (23 inches) fall 
from June to September; at Mazatlan 25 out of 35 inches 
fall from July to September, whereas February to May 
are almost rainless. 

In the upper Colorado Valley, in Colorado, southern 
Utah and Nevada, the type is mixed, with no well- 
marked annual period; the rains of the Southwest as well 
as those of the Great Basin almost disappear, so that 
the total is phenomenally small for the elevation and 
rugged topography. 



Jan. 


Feb. 


Mar. 


April 


May 


June 


July 


Aug. 


Sep. 


Oct. 


Nov. Dec. 


Year 


0.8 


0.4 


0.6 


1.0 


0.8 


0.4 


0.8 


1.2 


0.8 


0.8 


0.8 1 0.6 


9.0 ins. 



There are 90 wet days at Santa Fe, and only 45 at 
Phoenix; the combination of usually very light rains 
with rare cloud-bursts characterizes this section as well 
as the northern Plateau. There are about 30 days with 
three feet of snow in the higher uplands, three days with 
as many inches at El Paso, and a few flakes about once 
in two years at Phcenix. As the rainy season occurs in 
midsummer, thunderstorms are relatively common, 20 
to 40 per year. Tornadoes are quite unknown, and 
general storms of the usual description are rare, for the 



CLIMATOLOGY OF NORTH AMERICA 



135 



great barometric depressions rarely pass through this 
district; some recent winters have, however, proved 
exceptional in this regard. The terrific dust storms, 
which are especially common in spring, more than make 
up in discomfort for the absence of the wet spells of the 
eastern states. 

VII. The Pacific Coast. We may begin the review of 
this region with a glance at the deserts near the Colorado 
River. Here the winter rains, such as they are, already 
predominate, and but little moisture strays in during the 
summer from the Gulf of California ; the total precipita- 
tion is very small throughout, as follows : 





>> 
u 
o3 

3 
C 
o3 

>-5 


>> 

s- 
o3 

2 


u 
e3 


a, 
< 


>> 

03 


c 

3 




on 

a 

3 
< 


u 

£ 

OJ 


0) 
O 
o 
O 


u 

S 
> 

o 
S5 


a 

Q 


DO 


Southeastern California . 


0.6 


0.6 


0.4 


0.2 


0.0 


0.0 


0.2 


0.2 


0.1 


0.2 


0.2 


0.8 


3.5 



At an elevation of even 3,000 feet, the total is but 
little higher; in the great depressions below the sea level, 
it is barely two inches. Almost- infinitesimal as are these 
amounts, they even so are chiefly due to cloud-bursts, 
occurring at long intervals ; thus, Yuma had three inches 
of rain in February, 1901, of which 2.6 fell in twenty- 
two hours; the three- preceding years, added together, 
had yielded but little more, 1899 only 0.6 inch. Yuma 
has only 13 rainy days in the year, 8 of them with 
thunder, and a few flakes of snow are seen about once in 
a decade. 

California has a singularly uniform type of precipita- 
tion. The greatest amounts fall in the northwest corner 
and the Sierra Nevada, 50 to 60 inches; the total declines 



136 



THE CLIMATIC TREATMENT OF CHILDREN 



rapidly as we go southward, and becomes insufficient for 
agriculture at the 35th parallel on the coast and at the 
38th inland. We may glance at the following table: 



South California Coast. 
Middle California Coast 
North California Coast . 



Fresno 

Sacramento Valley. 



3 

s 
a 


>> 

3 
u 

<D 

ft 


o 
u 

1 


a 
< 


>> 


0) 

3 


3 


02 

1 

3 


a 

a 

CO 


u 
n> 

-Q 
o 
o 

O 


u 

O) 

S 
> 

o 


a 

O 

o 

Ol 

Q 


2.4 
4.8 
7.6 

1.4 
4.2 


2.8 
3.8 
6.8 

1.2 

3.6 


2.2 
3.0 
6.2 

1.2 
3.2 


1.2 
2.0 
4.2 

1.2 
2.2 


0.4 
0.6 

2.8 

0.4 
1.2 


0.1 
0.2 
1.2 

0.2 
0.4 


0.0 
0.0 
0.2 

0.0 
0.0 


0.0 
0.0 
0.2 

00 
0.0 


0.1 
0.2 
1.4 

0.2 
0.6 


0.6 
1.2 

2.8 

0.4 
1.2 


1.2 
2.4 
5.2 

1.2 
2.6 


3.0 

4.8 
7.4 

1.6 

4.8 



14.0 
23.0 
47.0 

9.0 
24.0 



Seventy per cent, of the total falls during the four coldest 
months, practically none at all during the four warmest. 
The number of rainy days ranges from 35 in the extreme 
southwest to 130 in the northwest corner; snow is almost 
unknown in the lowlands, except to the north of latitude 
40, where a trifle falls about once a year; in the northern 
high Sierra the amount of snow locally exceeds thirty 
feet, probably the highest figure on our continent; the 
reason being, of course, that most of the very heavy 
precipitation falls in winter. Thunderstorms are very 
rare, numbering only about two a year and usually 
occurring in winter. The local proverb, that earth- 
quakes are more destructive than lightning, has unfor- 
tunately obtained only too ample verification. 
. In Lower California, as we approach the tropics, sum- 
mer rains appear once more, the winter rains continue 
to fall off, so that the southern tip of that peninsula pre- 
sents a distribution resembling that noted ior Mazatlan, 
only in smaller quantity; exact data are not extant. 

The worst feature of the otherwise magnificent climate 
of California is the irregularity of the winter rains. In 



CLIMATOLOGY OF NORTH AMERICA 



137 



the southern part of the state rain falls only if the 
transcontinental storms are unusually severe, or take 
a somewhat southerly course; the feebler depressions 
entering the continent at Puget Sound bring little rain 
to the south of Point Reyes. At San Francisco the 
annual amounts have been 8 and 50 inches; by way of 
contrast, we may note that in the moderately variable 
climate of New York, the corresponding figures are 36 
and 59 inches. The mean annual variability of the 
precipitation is about 25 per cent, in San Francisco, 
and less than 10 in New York. 

In western Oregon, Washington and British Columbia, 
also in southern Alaska, there is some rain in summer, 
but the winter precipitation attains such enormous pro- 
portions that the seasonal ratio differs but slightly from 
that prevailing farther south. There is, however, as we 
go northward, a tendency of the maximum and minimum 
to move forward to autumn and spring respectively, so 
that, as we approach the subarctic regions, the type 
gradually approximates to that of the circumpolar region 
in general, as noted for Labrador and Greenland. 

The following table gives details "by months : 



>z 



Int. W. Oregon. 
Wash. & Or. C'st 
Puget Sound . . . 
Br. Col. Coast . . 
Sitka 



5.4 4.63.02.2 1.60.40.4 

11.81 8.4 8.2 7.04.23.6 1.6 1.8 

6.4: 5.0; 4.03.42.4 1.40.60.6 

11.0 12.6 10.4 8.6 4.63.44.66.0 

9.6:10.410.06.25.03.65.26.8 

I I I I I I 



1.4 3.4 4.8 7.2, 41.0 
5.4 7.6 11.2 13.2 83.0 
2.4 3.6 6.61 7.6 44.0 
8.8 12.213.413.6108.0 
11.2 13.413.6 10.0105.0 



The wettest region in North America is probably the 
west coast of Vancouver Island, where a three years' 



138 THE CLIMATIC TREATMENT OF CHILDREN 

record at Quatsino gives 130 inches; the Queen Char- 
lotte Islands possibly have a similar amount; farther 
north, as at Sitka, there is again a gradual falling off. 

The enormous totals of the winter months are quite 
uniformly distributed, and especially large amounts in 
24 hours are unusual; the rule is an inch or two a 
day falls for several days at a time. The seasons vary 
much less than in California, and the heavy winter rains 
can be depended upon with perfect confidence. 

The number of rainy days rises from 150 days at Rose- 
burg to 215 at Tatoosh Island, the amount per day 
.ranges from 0.24 to 0.45 inch, with perhaps slightly 
higher figures at the wettest places. The number 
of snowy days is only 8 to 12 in western Oregon, 
rises rapidly northward, but does not reach 40 even on 
the south Alaska Coast, for here also most of the winter 
precipitation falls in the form of rain. The depth of 
snow ranges from about a foot in southern Oregon to 
two feet near Puget Sound, and four or more in the 
north. Thunderstorms are infrequent, two or three a 
year; tornadoes are -quite unknown. 

Rain Intensity. By this term we may designate the 
amount of rain for each rainy day, an important matter 
for the medical climatologist. It may readily be cal- 
culated for each district by dividing the total precipita- 
tion by the number of wet days, but for the sake of 
convenience I have outlined the data in our possession 
on the opposite chart. 

We thus readily observe the torrential character of the 
rains in the southeast and, to a less degree, on the North 
Pacific Coast, as well as the tendency to light or drizzling 
rains in Canada and the arid Rocky Mountain belt. 






CHAPTER III 

HEALTH RESORTS 

We shall find it most convenient, for practical pur- 
poses, to divide our health resorts into the two groups 
of North American and foreign. In considering the 
former, the preceding chapter relieves us of the task of 
stating climatological figures; we have therefore more 
space for other details. In the case of foreign resorts, 
numerical data will often be required; they are nearly 
all given according to Hann, our most trustworthy guide 
in this field; comparison with American resorts of similar 
type will form a conspicuous feature of this subdivision. 

NORTH AMERICAN RESORTS 

Greenland and Labrador. In recent years, these bleak 
regions have repeatedly been suggested as summer sta- 
tions for the treatment of tuberculosis; the good results 
obtained during the colder months in temperate regions 
have called forth the endeavor to make them perennial, 
by removing tuberculous subjects' to a cold summer cli- 
mate, for it is notorious that the hot days of our summers 
are more or less injurious to them. In a recent article, 
Sohon 1 admits that these regions are to be considered 
only for the summer months; he praises them highly for 
their ample sunshine, even temperature, and freedom 
from dust and other atmospheric impurities. Exception 

American Medicine, April 23, 1904. 
139 



140 THE CLIMATIC TREATMENT OF CHILDREN 

may be taken at once to the first statement; although 
the subarctic June day has a length of 18 hours in 
Labrador, and 21 in southern Greenland, so much de- 
duction must be made for clouds and fog, that the net 
amount of sunshine is probably rather less than in middle 
latitudes. The evenness of the temperature is rather a 
demerit, especially when we consider that the essential 
principle of the cold climate treatment consists in hard- 
ening; all the arctic explorers agree in saying that they 
feel the chilly dampness of the far northern summer more 
keenly than the intense cold of winter; the very steadi- 
ness of the temperature makes the body extremely sensi- 
tive to slight changes; and the risk of catching cold is 
practically limited to the mild season. The summer of 
Greenland or Labrador does not even remotely resemble 
the winter on the Riviera, although the average tempera- 
ture is the same. 

Purity of the air is the one incontestable merit of 
these regions, shared, however, with most other and 
milder seaside resorts; it can, of course, be secured only 
on shore, not in the narrow and stuffy ship's cabin. In 
the similar summer climate of Spitzbergen a hotel has 
been started with some success; any permanent utiliza- 
tion of our subarctic regions must include some such 
facilities. A standing objection to this method of treat- 
ment will always be the stormy and sometimes perilous 
voyage to the far northern seas. 

The Maritime Provinces. Eastern Canada and New- 
foundland have not come much into vogue as health 
resorts, though the cool summer, resembling that of the 
British Isles, should alone be a sufficient recommenda- 
tion. Nova Scotia and New Brunswick, in particular, 



HEALTH RESORTS 141 

quite fulfill the ideal of such persons as. desire a really 
cool summer at the seaside, • with not too much wind 
and dampness; August and September are the best 
months, as fogs and rainy spells are not uncommon in 
June and July. The spring months are very disagreeable 
in the Maritime Provinces, owing to frequent changes to 
cold and dampness when the wind shifts to the north- 
east. The late autumn and the winter are subject to 
violent gales, with heavy rain or snow, though there are 
some very fine days even at those seasons. 

Data have been given for a number of stations in this 
section; others might be mentioned, but accommoda- 
tions are primitive at all the smaller and many of the 
better known resorts. The fare, in particular, is rarely 
such as would benefit an invalid, and improvement in 
this respect would do much to enhance the popularity 
and merits of this region. 

The- Maine Coast resembles the preceding section 
rather closely, but is decidedly brighter and colder in 
winter, and, toward the south, much warmer in summer; 
in Portland the heat sometimes becomes unpleasant, 
whereas hot weather is a great rarity at Eastport. The 
popularity of this coast, during the summer and early 
fall, is fully merited, though its climate is hardly superior 
to that of New Brunswick or Nova Scotia. Accommo- 
dations are, however, far better, sometimes of the first 
class, and this point must be allowed to weigh heavily 
in the selection of a health resort. The worst month in 
this region, as in most of New England, is April, on 
account of the melting of the snow and the frequent 
chilly northeasters from the Grand Banks. 

Climatic data have been given for a number of resorts. 



142 THE CLIMATIC TREATMENT OF CHILDREN 

In addition we must mention Grand Manan, Campobello 
and other islands in Passamaquoddy Bay, near Eastport, 
but belonging to New Brunswick; Sorrento, opposite 
Mount Desert Island; Castine and Camden at the mouth 
of the Penobscot; the islands off the mouth of the 
Kennebec ; and Scarborough Beach, Old Orchard Beach, 
and Kennebunkport, near Portland. 

The Mountains of Northern New England. The variety 
of resorts in this region is very great, and the visitor 
may select anything from the most fashionable hostelry 
in a popular locality, to the almost uninhabited wilder- 
ness north of the Canadian Pacific Railway. Some sec- 
tions are partly cultivated, others consist chiefly of bare 
or wooded mountain side, others again present a tangle 
of small or large lakes and streams. The free and easy 
type of consumptive has not yet invaded this region to 
any great extent, to impair it for other persons, as has 
happened in the Adirondacks. The higher resorts form 
the favorite refuge for the victims of hay-fever, who are 
quite sure to obtain relief at elevations above 1,200 feet. 

Black flies and mosquitoes are troublesome in early 
summer in the heavily forested sections, but absent in 
the open country; malaria is unknown. The best sea- 
son for children is from the middle of July to the middle 
of September, after which date there are apt to be 
heavy night frosts and some rather raw days. The win- 
ter is altogether too cold for young subjects, and exer- 
cise out of doors is greatly interfered with by heavy 
snow and generally bad weather; only adults should be 
permitted to brave this climate from November until 
April. The early spring is the worst season of all, on 
account of the slushy conditions that attend the melting 



HEALTH RESORTS 143 

of several feet of snow, which is apt to take place very 
suddenly late in March or early in April, and render all 
the roads quite impassable. 

Whole pages might be filled in naming all the avail- 
able resorts. I mention only the Rangeley Lakes and 
Moosehead Lake in upper Maine (see Kineo in the table), 
Poland Springs and Belgrade in the lower levels of the 
same-state (elevation 800 feet) , the entire White Moun- 
tain and Winnipesaukee districts in New Hampshire, and 
practically every nook and corner of Vermont. The 
last named state affords about the best summer climate 
in the East, if not on the continent, being just comfort- 
ably cool, and neither too wet nor too dry; good accom- 
modations are obtainable at dozens of places, too many, 
in fact, to be enumerated. 

The Coast from New Hampshire to Long Island. We 
gradually leave the cool summer of the Northeast behind 
us, but, until we reach Boston, the temperature is still 
very agreeable, and prolonged hot spells are uncommon. 
Below Boston, we begin to note a tendency to sultriness, 
which increases steadily as we advance toward New 
York City. The situation of stations with reference to 
the sea breeze here becomes of importance; localities 
facing south or east are much cooler than such as face 
west or north, the latter getting a good deal of hot 
weather and being more or less deprived of winds from 
the ocean. Thus, the so-called South Shore of Massa- 
chusetts Bay is very decidedly inferior to the Cape Cod 
Peninsula and the districts near New Bedford and New- 
port ; similarly, the ocean front of Long Island is prefer- 
able to the Sound front, which is again less desirable 
than the Connecticut Coast. Hot weather is entirely 



144 THE CLIMATIC TREATMENT OF CHILDREN 

unknown at Nantucket, Martha's Vineyard, and Block 
Island, but the nights are no longer very cool, so that 
the climate is a trifle enervating to all save young chil- 
dren, who often require moist and moderate warmth. 
The south shore of Long Island is warmer, on account of 
hot winds from the interior, when the sea breeze fails; 
there is a difference of three degrees in the average July 
temperature between Montauk Point and Rockaway. 
Malaria of a mild type occurs here and there in the 
marshy districts, which it is wise to avoid for this reason. 

The winter grows steadily milder as we go south, be- 
coming decidedly open, in ordinary seasons, from Nan-, 
tucket to New York, where the effect of the ocean is 
most manifest. Here zero weather is rare, but high 
northwest winds and occasional severe storms are an 
objection that make the outer islands quite unsuitable 
for a winter sojourn. The proportion of sunny days is 
very great, and it would be worth while to try if south- 
western Long Island might not rival the New Jersey Coast 
as a winter resort, for it is only a degree or two colder. 

The objectionable east winds of spring become less 
serious as we advance west and south from Boston, and 
may be disregarded on Long Island, where the trans- 
itional month of March, with its uncertain mixture of 
winter and spring, is the worst of. the year. 

September and October are very fine in this section, 
although there may be*some rather warm weather in the 
former; in southern Connecticut and on Long Island 
November also affords beautiful weather in many years, 
for the winter frequently holds off until December in 
these districts. November snowfalls in excess of an 
inch occur only about once in four years on Long Island, 






HEALTH RESORTS 145 

and then invariably toward the close of the month. On the 
other hand, there is an even chance of some snow in April, 
which has,approximately the same average temperature, 
for the seasons are very much retarded in this region. 

From the legion of resorts we can single out but a 
few; namely, Portsmouth, N. H., and the Isles of Shoals, 
Cape Ann and the North Shore, offering a succession of 
first-class resorts, also no end of places in Barnstable 
County, Mass. The data given in the preceding chapter 
for Nantucket, Block Island, New Haven, and South- 
ampton give a good idea of the climate in Rhode Island 
and Connecticut, and on Long Island, and an approxi- 
mation to that of such places as Newport and Narragan- 
sett Pier; lack of space forbids a more detailed mention. 
The accommodations vary greatly, but are generally fair 
to good. On Long Island it will be well to avoid the prox- 
imity of the salt marshes, which begin here, and continue 
along most of the coast to the tropics ; they invariably 
involve a terrible plague of mosquitoes. 

The Adirondack Mountains. Northern New York has 
gradually become a vast sanatorium for invalids of 
all classes, but the unrestrained victim of tuberculosis, 
who roams about at will without systematic medical 
attendance, and often scatters infection broadcast, has 
begun to impair the value of this region for other persons. 
The climate of this section is practically identical with 
that of northern New England, but the choice of resorts 
is less varied, because of the preponderance of absolute 
wilderness. Such pleasant districts as the semi-cultivated 
valleys of Vermont are hardly to be found here, whereas 
the lake-strewn forest of northern Maine is duplicated 
on a similarly large scale, and much more accessible. 



146 THE CLIMATIC TREATMENT OF CHILDREN 

The lower elevations, among the foothills of the 
Adirondacks, offer the attractions of a more settled 
region; their situation is, however, generally somewhat 
low, involving a rather warm summer. Still, the low 
valleys occupied by Lakes Champlain and George will 
always prove attractive; Schroon Lake is a little higher 
(800 feet) and therefore cooler, and its natural beauties 
are considerable, but the real mountains are still many 
miles away. 

All the remarks as to the seasons and their respective 
merits, that were made concerning the mountains of 
northern New England, apply equally to the Adiron- 
dacks. In the forested sections, comprising by far the 
greater part, black flies and mosquitoes are a great 
plague until midsummer. 

Our space does not permit a recounting of the indi- 
vidual resorts in this region, which number scores. First 
class accommodations are, however, less common than 
in New England, and rather scattered, outside the 
Saranac-Placid district in the north. So far as ready 
accessibility is concerned, many localities are well pro- 
vided for, whereas others, equally good, are twenty miles 
and more from the nearest railway; this may be re- 
garded as an advantage under some circumstances, 
where rest and remoteness from the ordinary tourist 
travel are desirable. 

The St. Lawrence Valley. This region is similar to the 
last, except that the winter becomes intensely cold. 
Very scant provision has hitherto been made for the 
health seeker, and visitors are usually taken care of in 
very primitive fashion. Among the few exceptions 
to the last statement are Roberval (Lake St. John), 



HEALTH RESORTS 147 

Chicoutimi, Murray Bay, Quebec, Montreal, and Ottawa, 
but the last two are a little too warm in July and 
August. 

Below Quebec, the river broadens out into a great 
gulf, and the climate is very much like that of the Mari- 
time Provinces, with a colder winter. The lower St. 
Lawrence, beyond the mouth of the Saguenay, hardly 
comes within our ken; the climate is rather too raw for 
our purposes, even in midsummer. The upper reaches 
of the Ottawa Valley are now coming into vogue, but 
only for hardy sportsmen. 

The Hudson and Connecticut Valleys. Along the Hud- 
son and Connecticut Rivers we find no end of resorts, 
all of which are too warm for comfort in summer, and 
not severe enough in winter to guarantee a continuous 
snow covering and freedom from slushy surface condi- 
tions. As we ascend the hills on either side, both these 
objections disappear, and the Berkshire and Litchfield 
Hills, as well as the Shawangunk and Catskill Mountains, 
afford hundreds of attractive sites with a pleasant cli- 
mate. Few climatic data are available for this region, 
but we can calculate the temperature of any station 
fairly well by taking the figures for Poughkeepsie, and 
deducting one degree for every 275 feet in summer, and 
half as much in winter; in this manner we obtain the 
following values for the region near the 42d parallel in 
the Catskills and the Berkshire Hills: 



Elevation, Feet 


January 


July 


100 '. 


24 
22 
20 


72 . 


1,200 


68 


2,300 


VJ 


64 









148 THE CLIMATIC TREATMENT OF CHILDREN 

In the Catskill Mountains most of the resorts lie along 
the Ulster and Delaware Railroad and its branches, 
whereas Sullivan County is threaded by the Ontario and 
Western line; Delaware County is reached by both. 
East of the Hudson there is almost an infinity of good 
locations along the Housatonic Railway and the Litch- 
field Hills line, as well as along the New York and 
Harlem Railroad. In the Hudson Valley itself only the 
Saratoga region, in its upper reaches, can be recom- 
mended, and Saratoga Springs itself is too much of a 
resort of fashion to commend itself for medical purposes, 
save in the relatively dull early summer and fall; from 
late July until early September it is very warm and the 
life there is unsuited to every sort of invalid. 

The Hudson Highlands form a pretty, but, except 
near Newburgh, somewhat neglected hill country. The 
interior of Sullivan and Greene Counties, away from the 
railways, is ideal for restfulness, rivaling the best parts 
of New England. Unfortunately, the accommodations 
are second or third rate almost everywhere away from 
the main lines of travel. Malaria is unknown among 
the hills, not so in the lower Hudson and Connecticut 
Valleys. 

New Jersey. Northern New Jersey, away from the 
suburban region near New York, resembles the last- 
named section, but the elevations barely reach 1,200 
feet; the southern part of the state is low and flat, very 
warm and not over wholesome in summer, fairly mild in 
winter. The pine belt is well represented by Lakewood, 
which is to be avoided from June to September, but is 
highly attractive in April, May, October and November. 
The winter is not very mild, with a continuous variation 



HEALTH RESORTS . 149 

between snow and mud; the temperature occasionally 
falls near to and below zero. Up among the hills of 
northern New Jersey we must not fail to mention Lake 
Hopatcong, and the region traversed by the Greenwood 
Lake and Susquehanna and Western Railways. 

The coast is relatively mild in winter and cool in sum- 
mer, and affords at least a dozen first-class resorts, 
among which Asbury Park, Atlantic City, and Cape May 
rank deservedly high. It must, however, be admitted 
that the summer is not really cool; sultry spells are 
common, and a dozen or so of days in the nineties may 
be expected with some certainty; the nights are also 
either rather warm or marred by sea fogs. Thus, we 
must regard that season as decidedly enervating, and 
choose this section as a summer resort only because of 
its proximity to the great cities of New York and Phila- 
delphia. Neither is the winter especially mild, as it 
averages little above the freezing point in ordinary years, 
and below it in cold seasons; it is redeemed only by its 
wealth of sunshine, equaled in these latitudes only at 
favored spots on the Mediterranean, which are all very 
much warmer. Early spring suffers somewhat from 
damp east winds, but is otherwise agreeable; the late 
fall is almost perfect, and beyond criticism, but this 
season is the very one in which this coast is compara- 
tively deserted. 

The inland sections of southern New Jersey are hot 
and malarious in summer, and colder and cloudier than 
the coast in winter; this region has, quite properly, 
received little attention from medical climatologists. 

Central New York and Pennsylvania. This region 
presents a rolling country, with an elevation from 800 



150 THE CLIMATIC TREATMENT OF CHILDREN 

to 2,000 feet, varied at its northern edge by the pretty 
" finger lakes" of New York State. The data for 
Cooperstown and Scranton give a good idea of the 
temperature at the lower levels, higher localities being 
several degrees cooler in summer; as we go south, how- 
ever, the summer becomes rather warm, and in the lowest 
valleys, as at Harrisburg, the winter ceases to afford con- 
tinuous cold and a permanent snow covering. Coopers- 
town, Richfield Springs, Sharon Springs and a number of 
pleasant towns on the lakes represent only a portion of 
the great variety afforded in New York ; in Pennsylvania 
the popular resorts are fewer, for only Cresson Springs, 
Glen Summit, the Pocono Mountains, and a very few 
other places are sufficiently high to be pleasant in July 
and August. The Delaware Water Gap is indeed pic- 
turesque, but the midsummer temperature there is un- 
comfortably high, so that this resort is better adapted 
to the spring and autumn. 

Maryland, Virginia and West Virginia. In these 
states we are on the threshold of the South, and must 
begin to distinguish between summer and winter sta- 
tions. Hot Springs and White Sulphur Springs, as well 
as Deer Park, are specimens of the former, a little too 
warm for northern visitors in midsummer, who will do 
better to visit them in May or October; for southerners 
they afford welcome relief from the humid heat of the 
lowlands. The figures given for Wytheville give a good 
idea of the temperature. Northern visitors may occa- 
sionally avail themselves of the milder stations in winter, 
but in general will do better by going farther south, as 
this season in the yirginian Mountains is decidedly 
unsettled and wet. 



HEALTH RESORTS 151 

On the coast we strike the first really mild winter 
resort at Old Point Comfort, opposite Norfolk. Here 
zero is unknown, and severe cold rare, but there is still 
some snow and considerable frost, and the climate differs 
from that of Atlantic City only in being seven degrees 
warmer, an amount, however, worth considering, espe- 
cially in the transitional months of March and April. 
Virginia Beach is also known as a summer resort, but 
only for southerners, being decidedly too warm, damp 
and enervating for the northern visitor. 

The Lake Region. Notwithstanding its great extent, 
only certain portions of the Lake Region have special 
value as health resorts; these are somewhat scattered, 
and best taken up consecutively. 

In the northeast corner we have the Thousand Islands, 
for which the climatic data for Kingston, hear by, will 
answer very well; the summer is sometimes rather warm, 
but on the whole agreeable, the accommodations are of 
a high order. The stations on Lake Ontario take a very 
subordinate place; along the south shore the summer is 
considerably warmer than on the north shore, and the win- 
ter, while also warmer, is far more cloudy and unpleasant. 

In the Lake Erie district, we may begin with Lake 
Chautauqua, 650 feet above Lake Erie, and, therefore 
fairly cool in summer; the places on the American shore 
of the lake are apt to be very warm. On the Canadian 
side the summer temperature is pleasant, but there is 
said to be some malaria; Port Stanley is the best known 
station. Near Lake St. Clair we have Mt. Clemens, 
famous for its springs; the climate is, however, not 
especially attractive, except perhaps to summer visitors 
from the South. 



152 THE CLIMATIC TREATMENT OF CHILDREN 

Lake Huron has the great merit of affording a cool 
summer nearly everywhere, except at its southern tip; 
a number of resorts are coming into deserved prominence, 
especially on the cooler Canadian side. The shores of 
Georgian Bay, as well as the Muskoka and other near-by 
lakes, are annually affording better accommodations; 
apart from the less rugged landscape, this section is little 
inferior to the lake region of Maine and northern New 
York, and should rival the Thousand Islands for resi- 
dents of the western states, who will find it more 
accessible. Ample climatic data have been given, those 
for Parry Sound being quite applicable to the Muskoka 
region, save that the extremes of temperature may be a 
trifle greater, and the average a degree or two lower at 
the latter. 

The Michigan side of the lake is relatively undeveloped, 
though it is nearly as cool north of Saginaw Bay; land 
breezes, however, occasionally raise the temperature into 
the nineties, which happens less frequently on the 
opposite shore. 

There is an abundance of pleasant resorts along Lake 
Michigan, especially on the east shore, which is the 
cooler in summer. The finest summer climate is found 
near the straits, where numerous small towns afford good 
accommodations; the tables for Mackinaw give a good 
idea of the usual temperature, which is nearly the same 
as that of the Maine Coast; the salt air is, of course, 
lacking. On the opposite side of the lake we still have 
a fairly cool summer at Escanaba, but southward it grows 
warmer, though the. frequent lake breezes mitigate the 
heat even at Chicago. The mineral springs, near Mil- 
waukee, such as Waukesha, are much frequented, but 



HEALTH RESORTS 153 

are not cool enough to be bracing. Malaria is practically 
unknown in this section. 

The shores of Lake Superior have hitherto not re- 
ceived much attention; the south shore, while generally 
cool, occasionally experiences some very intense heat, 
which is not so apt to occur in the Mackinaw district; 
Marquette represents this section well. The north side 
of the lake has so far been neglected; the summer is al- 
most too cool at stations like Port Arthur, and other 
places are not very accessible; facilities for the care of 
tourists hardly exist on the Canadian shore. Among the 
hills, such settlements as White River afford a bracing 
summer climate, but this territory has hardly come 
within the scope of the health seeker. 

None of the lake points are adapted to a stay from 
November to April, the weather is too stormy, gloomy, 
and changeable, and the raw Winds of early spring are 
even worse than in New England. At favored sites, 
however, the month of May becomes pleasant, and from 
June to September the weather is good everywhere, save 
that midsummer is a little too warm on the south shore 
of Lake Erie, and in the vicinity of Chicago, which are 
objectionable in other ways. 

The Ohio Valley. This region has little to offer in the 
way of health resorts; it shares in most of the disadvan- 
tages of the Mississippi Valley, to be considered later. 
French Lick and West Baden Springs, in southern 
Indiana, are much visited; their climate is a trifle 
warmer than that of Indianapolis (q. v.) and therefore 
far from attractive in either winter or summer. 

The Upper South. Here we find a number of resorts 
worth mentioning in detail. Asheville, for which data 



154 THE CLIMATIC TREATMENT OF CHILDREN 

have been given, is the best known, and its value is not 
limited to the treatment of tuberculosis alone; the sum- 
mer is, however, a little too warm for northern visitors, 
though affording welcome relief to residents of the 
southern lowlands. There is an occasional fall to zero 
in winter, with some snow, and a good deal of rain; the 
hills and dense forests furnish ample shelter from high 
winds; the whole upper South is, in fact, the least windy 
section in the entire East. 

Hot Springs, N. C, 1,300 feet high, is a degree or two 
cooler than Charlotte, and therefore mild in winter, but 
very hot in summer. Lookout Mountain, 2,130 feet 
high, near Chattanooga, is a trifle warmer than Asheville, 
therefore generally similar, but much more exposed and 
hardly suited to a winter sojourn. The country about 
I^noxville merits a more extended trial than it has had 
hitherto, it lies particularly well sheltered and the tem- 
perature is fairly uniform. 

All the places mentioned may safely be recommended 
for the spring and fall (except September). The upper 
South is remarkably free from malaria, considering the 
rather high average temperature, and presents a striking 
contrast to the lower South in this respect ; its utilization 
is, however, still in its early stages, and awaits a much 
greater future. 

The Lower South. This region can, in general, be 
recommended as a health resort only from November to 
and including April ; the rest of the year is too warm, and 
malignant fevers are common during the rainy season 
from May to October, when the coast marshes have a 
particularly evil reputation. We shall take up the 
various localities from north to south. 



HEALTH RESORTS • 155 

Raleigh and Southern Pines, near by, have a winter 
that is still moderately cold, with some snow and frosty 
nights; the latter station is a little the milder and well 
sheltered from high winds. Aiken, S. C, and Augusta, 
Ga., are decidedly mild, some vegetation persisting in all 
but the coldest winters; still, sharp freezes are common, 
though snow is rare; Macon is very similar. Charleston 
and Savannah are not so typically urban as to be objec- 
tionable; they have the average winter temperature of 
southern California or Sicily,, but the occasional hard 
frosts constitute an important difference; Thomasville is 
similar, but a little drier, .lying well sheltered among the 
pines. Jacksonville, St. Augustine and Pensacola are 
almost subtropical, but still present all the eccentricities 
of the southeastern winter; Mobile, New Orleans and 
Galveston are similar, but a little colder, and not quite 
as suitable to invalids as the resorts of northern Florida ; 
the defective sanitation of New Orleans is a standing 
objection to that otherwise charming winter refuge. 

The entire region just outlined is better suited to the 
period from late February until mid-April than to 
the true winter season. During the midwinter months, 
the before-mentioned eccentricities of the southern cli- 
mate have full play; the visitor suffers from a perilous 
and all too frequent alternation of heat and frost, the 
bad effects of which have already been fully considered; 
it is an exaggerated northeastern April that the southern 
winter affords us, not uniform balminess, as advertised. 
The effect is a mixture of pampering and hardening 
which is of doubtful benefit to those who are referred to 
this region. In spring the climate is rather good, March 
in Georgia resembles April in Virginia and May in New 



156 THE CLIMATIC TREATMENT OF CHILDREN 

England; the late fall should also be quite healthful in 
this district, but the experiment has been tried so little, 
that most of the resorts are not even open in November. 

The Florida Peninsula. Data have been given for 
Tampa and Jupiter (Palm Beach) ; the temperature for 
other popular resorts, such as Miami, Ormond and Pa- 
latka, may readily be calculated from those mentioned; 
it remains for us to generalize. The first common mis- 
take . is to speak of Florida as if it had one climate, 
whereas the winters of Jacksonville and Key West differ 
by 15 degrees, and the average minimum temperatures 
by almost twice as much. At the former place January 
resembles late April and early May in New York, save 
for hard frosts that are more appropriate to March than 
May; at Key West we have the climate of the New York 
June, though occasional chilly spells occur that have no 
counterpart in the northern month of roses. 

The second mistake is to put off the southern tour to 
the latter part of the winter, say February, and then 
transport the invalid from Boston or Chicago to Palm 
Beach or Miami, which are forty degrees warmer, with- 
out breaking the journey. Some days after arrival, 
when the process of enervation is fairly started, the 
visitor is' surprised by a norther, with a temperature near 
the freezing point, and runs at least an even chance of 
catching a severe cold. An " unusual " season — the ordi- 
nary mixed-up weather of the Florida winter is always 
called " unusual" for the benefit of visitors — is apt to 
leave the patient worse off than before. Fortunately, 
a wise custom postpones the return north until late 
April or May, and accomplishes it gradually; to take 
the enervated subject at once back to Boston in the 



HEALTH RESORTS 157 

inclement weather of early spring would undoubtedly 
involve disaster in many a case. 

The third error, a common one, consists in keeping the 
patient in the increasingly warm and moist climate of 
south Florida until the fashionable season is over, in 
mid- April. Enervation is the chief danger to be appre- 
hended, it is quite certain to be accomplished by a pro- 
longed residence in this region. For this reason, the 
absolutely tropical, yet changeable, winter of Key West 
and Havana is to be avoided altogether; the latter city 
has a number of other drawbacks that need not be gone 
into here. 

There is a vigorously defended tradition that malaria 
is less frequent in Florida, than farther north; this may 
be true for the Atlantic Coast, with its trade winds, but 
it certainly does not apply to the West Coast during the 
warm months, where such places as Tampa have an 
unsavory reputation. The excessive humidity alone is 
extremely depressing to any one not a native ; this forms 
an objection to southern Florida even in winter, the dry 
season. On the whole, this region cannot be compared 
with southern California, or even the western Riviera, 
as a winter health resort ; its chief merit is its relative 
accessibility, and its luxurious accommodations for 
visitors. 

On the whole, it is probable that the upper South is 
often to be preferred to the lower South, and this in turn 
to Florida, in the treatment of disease; this rule, natur- 
ally, admits of many exceptions, but I am convinced that 
longer experience, even with children, will eventually 
bear out this statement. 

The Bermuda Islands. What has been said of Florida 



158 THE CLIMATIC TREATMENT OF CHILDREN 

applies equally to the Bermudas. There is, indeed, a lack 
of the sudden and trying changes that characterize the 
former region, but the process of enervation is thereby 
only the more thoroughly accomplished, and it is worth 
mentioning that this result of a stay in the Bermudas 
has always been recognized as a serious demerit. The 
Bermudas have a certain therapeutic value, but their 
climate is a less important factor in their usefulness 
than their remoteness from the ordinary highways of 
commerce. 

The Mississippi Valley. This region is of little value 
for our purposes. The winter is about the most change- 
able in the world, and grows quite insalubrious toward 
the south, where the frequent warm and humid spells 
add the danger of enervation; the more severe but less 
interrupted cold of Minnesota and Iowa is far safer. The 
summer is hot everywhere; malaria is rife as far north 
as Illinois and Iowa, and the malignant types of fever 
are not rare in the river bottoms, though this last cir- 
cumstance is not often referred to in print. 

Almost the only health resort in all this vast district 
is Hot Springs, Ark., where the climate is really pleasant 
only in spring and autumn. The elevation of this town 
is 480 feet, and the data given for Little Rock, near by, 
give a very adequate idea of the climate, the winter being 
quite cool and very changeable, the summer intensely 
hot. 

The Great Plains. When the Great Plains were first 
settled much was said about their remarkable salubrious- 
ness, but we hear little of that to-day. The Canadian 
Northwest, however, is bracing and healthful, if one can 
endure the terrible cold of the long winter, which has the 



HEALTH RESORTS 159 

compensating feature of being fairly bright and sunny, 
free from rain, mud and slush, and with a moderate snow- 
fall that lies on the ground until April. The summer 
temperature is, on the whole, quite agreeable; the occa- 
sional very hot days are tempered by a low relative 
humidity and frequent refreshing showers, and the nights 
are quite uniformly cool. 

Some of the merits of the Northwestern Provinces of 
Canada are shared by North Dakota and eastern Mon- 
tana, but the summer heat here is occasionally very 
intense; farther south, the climate has few attractions. 
The extremes of temperature are felt most severely, the 
high winds are exceedingly trying, and the low humidity 
acts chiefly by increasing the amount of dust. The 
scorching blasts of summer, the blizzards of winter, and 
the constant peril from tornadoes from April to August 
do not contribute to the otherwise scanty climatic attrac- 
tions of this section which, all in all, is one of the worst 
on the continent for neurotic persons. The dryness, 
furthermore, is not sufficient to afford protection against 
malaria, which begins to be of moment in Nebraska, and 
becomes a serious evil in many parts of Oklahoma and 
Texas. In the last-named state the summer ceases to 
be really dry, owing to the predominance of the Gulf 
winds at the season named, and the climate becomes 
extremely unwholesome in the river valleys. 

The Rocky Mountains. We must consider the Rocky 
Mountains with some little minuteness, if only because of 
the great variety of health resorts that they afford; in 
this respect they are perhaps destined to surpass any 
other portion of the continent. In the following account 
we shall again stop at the 37th parallel, for the Southwest, 



160 THE CLIMATIC TREATMENT OF CHILDREN 

while not inferior, presents conditions so different as to 
call for separate discussion. 

In the Canadian Rockies, the summer is rather cold, 
but the winter is not unduly severe for the latitude and 
elevation, save on rare occasions, when the thermometer 
may fall to 30 or 40 degrees below zero. The Canadian 
Pacific Railway has done much to furnish quite good 
accommodations in this section, which resembles the 
Swiss Alps in scenery and climate; the data for Banff 
give a good idea of the latter. 

In the United States the eastern slope still has a rather 
changeable winter, but the average is relatively mild; 
the winds are less violent than on the plains, with the 
exception of the warm and very dry Chinook; there is 
usually little snow, and a low humidity, but the clearness 
of the sky has been overstated, except for southern 
Wyoming and Colorado. Spring is the least pleasant 
season, being relatively, but only relatively, moist, 
cloudy, and rainy. The summer is bright, with rather 
hot days, and very cool nights, occasional thunderstorms 
in the afternoon, and a very low humidity, which makes 
even 95 degrees in the shade tolerable. The fall is de- 
lightfully bracing, with warm clear days, and frosty 
nights, merging almost imperceptibly into winter. 
Ample tabular data have been given, and we need only 
mention that the best accommodations are offered at 
Helena, Denver, Manitou and Colorado Springs, whereas 
at most 'other places, otherwise quite as desirable, they 
are apt to be primitive. 

In among the mountains there is a little more moisture, 
and some situations are fairly well forested. Good 
accommodations are obtainable in the Yellowstone Park 



HEALTH RESORTS 161 

— rather cold and open only in summer — Glenwood 
Springs, and Ouray, Col.; elsewhere they are usually 
primitive. Leadville is too high and cold for most 
people; snow falls there even in midsummer; at Grand 
Junction the summer is rather hot. 

In the Great Basin the climate is somewhat different; 
the winter is not so very bright, and brings some rain and 
snow, this weather continuing until late spring; the 
summer is warm, with almost uninterrupted sunshine; 
the autumn is like that on the eastern slope. An objec- 
tionable feature is the barrenness and dust in summer; 
the heat is rendered endurable by the extremely low 
humidity, but more rain would be welcome. High winds 
are a trying feature in exposed situations, as at Carson 
City and Winnemucca; they are not intolerable at Salt 
Lake City, where alone there are ample accommodations. 
Data have been given for the places mentioned ; the even 
temperature in western Nevada is worthy of note, also 
the usually steady winter temperature everywhere, in 
marked contrast to the thermometric oscillations of the 
entire east, including the slope. 

The relative warmth of the Snake River Valley was 
noted in the preceding chapter; the summer is, however, 
too dry to be oppressive; the winter is wonderfully mild 
for the latitude, but rather cloudy, though not very wet. 

The Southwest. Here we shall merely endeavor to 
amplify our tabulations. In northern New Mexico we 
have Santa Fe and Las Vegas Hot Springs, with temper- 
atures that rarely go beyond zero and 90 degrees, a dry 
winter, and a summer that is also dry, but nevertheless 
has abundant showers. Albuquerque is mild in winter, 
a little warm in summer, accommodations are not very 



162 THE CLIMATIC TREATMENT OF CHILDREN 

good; the last is also true of El Paso, where the summer 
is uncomfortably hot, in spite of the low humidity. 
Silver City has become a popular health-resort, the cli- 
mate being very equable. 

In Arizona we have a great variety of climates. Yuma 
and Phoenix afford one of the best warm and dry winter 
climates known; with a mean temperature resembling 
that of Jacksonville and Charleston, and a much greater 
daily range, they are still far less liable to sudden changes 
and hard frosts. Their summer, however, is intolerably 
hot, and the humidity in July and August is not espe- 
cially low, so that the heat is quite unendurable. Tucson 
has a similar climate, but slightly cooler at all seasons; 
the deserts of southeastern California are uninhabitable 
during the warm months. None of these places except 
Phoenix have really good accommodations. 

In the uplands of Arizona we find a pleasantly cold 
winter, with some sharp weather, but very little snow, 
and in summer moderately hot and dry days, with occa- 
sional showers, and cool nights. Prescott offers fair 
accommodations, and there is now a good hotel at the 
edge of the Grand Canon; most of this fine district, how- 
ever, is for the present undeveloped. 

The Mexican resorts on the plateau must not be for- 
gotten; unfortunately the accommodations for health 
seekers, except in the capital, are rudimentary, and the 
City of Mexico, in spite of a good climate for such as can 
stand the altitude, is objectionable from other points of 
view. The tables given in the preceding chapter are 
amply sufficient for conveying an idea of the climate on 
the plateau, with its charming winter and only moder- 
ately hot summer. The dry season lasts from October 



HEALTH RESORTS 163 

to April or May; moderate rains fall during the rest of 
the year, and even the rainy season has plenty of sunny 
days. There is a promising and still almost virgin field 
for enterprise in the highlands of Mexico, as well as in 
our own Southwest. 

We may now pass on to the Pacific Coast districts, 
which include so many very different climates that we 
are obliged to make a number of subdivisions. 

Southern California. The southwestern corner of Cali- 
fornia has probably the finest climate in the world, with 
only a tendency to drought to set against its many merits; 
ample tables have been given to illustrate such matters 
as can be reduced to figures, but a few additional remarks 
are necessary for a complete description. The summer 
temperature varies exactly according to the distance 
from the California Coast Current; Santa Catalina 
Island having a perpetual spring, Santa Barbara and 
San Diego a few hot days, Los Angeles and Pasadena 
some intense heat when the desert wind blows, fortu- 
nately with a low humidity; at San Bernardino and 
Riverside the summer, in general, is a little too warm for 
real comfort, though the nights are still cool. After 
crossing the Coast Range the heat rapidly becomes intol- 
erable, quickly increasing as we descend into the desert. 
In winter all this is changed, and the temperature is a 
trifle higher on the coast and islands than inland, declin- 
ing with the elevation in the usual way. Temperatures 
below the freezing point are very rare on the coast; inland 
25 degrees are recorded on some occasions, but only the 
tenderest vegetation is likely to be injured. In summer, 
the afternoon fogs are apt to be annoying, but they are 
less frequent than farther north, and are attended with 



164 THE CLIMATIC TREATMENT OF CHILDREN 

less violent west winds. The best season is unquestion- 
ably from December to May, the defects of the summer 
have been mentioned, the autumn has some hot days, 
even so late as November and, generally speaking, the 
only rather unsettled weather of the year. No other 
region affords an equal number of days suitable to out- 
door life, and in wealth of sunshine this strip of country 
is little inferior to the desert itself. The winter is an 
almost perfect reproduction of October in southern New 
York and New England. 

All the places mentioned offer good accommodations, 
and there are others, excluded only from lack of space. 
Not the smallest merit of this region lies in the fact that 
malaria is unknown, in marked contrast to places in the 
Old World having a similar climate. 

Central and Northern California. In this region we 
encounter a number of widely different climates, which 
must be discussed separately. The coast of middle Cali- 
fornia is delightful in winter, almost equaling the south- 
ern resorts; Monterey is the favorite, but Santa Cruz is 
not inferior. In summer, however, the coast is damp, 
foggy and windy, and best avoided by all save the very 
robust; there are some hot days in May, June, Septem- 
ber and October, rarely in midsummer, when the sea 
breeze is unpleasantly strong and constant ; the best sea- 
son, therefore, is from November until April or May. 

The interior is a little cooler in winter, with some frost, 
and rather more cloudy weather than on the coast, a 
common phenomenon, as already observed; the summer 
is almost absolutely cloudless and very warm, the heat 
increasing as we go farther from the Golden Gate. Even 
the low humidity does not compensate for the high' after- 



HEALTH RESORTS 165 

noon temperature, although the nights are generally 
comfortable. The peculiar distribution of temperature 
about San Francisco has already been fully described. 

The North California Coast only remotely resembles 
that farther south; the temperature in winter is only a 
few degrees lower, but there is an excess of rain and 
storms that makes this season disagreeable ; the summer 
is even damper than that of San Francisco, which is say- 
ing all that can be said; the climate cannot be recom- 
mended at any season, and the very equable temperature 
does not atone for the exceedingly disturbed condition 
of the atmosphere at nearly all times of the year; only 
the autumn is a little better in this respect. 

The very pleasant and bracing climate of the mountain 
region of northern California has barely been utilized. 
The winter is not really cold at ordinary elevations, but 
there is a good deal of rain and some snow; the summer 
is fine, not too warm, but a little too dry, and a few 
showers would be an improvement. In the wonderful 
coniferous forests, however, the dust is not so objection- 
able as it is, to a distressing degree, in the Californian 
lowlands. 

Oregon and Washington, The coast of these states has 
the defects of that of northern California, plus an even 
more rainy and stormy winter, with occasional hard 
frosts; the Coast Range here is not high enough to afford 
perfect protection against the cold waves coming from 
the interior; and east winds are altogether commoner 
here than in California. The interior has a climate 
closely resembling that of southern England and north- 
ern France, but very much finer in summer, when a 
rainy day is rare. The summer is also very dry, though 



166 THE CLIMATIC TREATMENT OF CHILDREN 

not to the degree encountered in California, and the 
sensible temperature is low, with very cool nights. 
Many of the small towns of this region offer very good 
accommodations, and even the cities are less objection- 
able than in the East, especially as they are mostly of 
only moderate size. Olympia is perhaps the best sit- 
uated of all, as it lies well sheltered, the other places 
on Puget Sound are a little too much exposed to the 
winter storms; in Oregon such places as Salem (near 
Portland) and Roseburg may be recommended with 
confidence. 

Behind the Cascade Mountains the climate differs 
radically, and - partakes of the characteristics of the 
Great Basin, with a moderately cold, but not too change- 
able winter, which brings some rain and snow, and a very 
dry and warm summer, not very different from that of 
the interior of California, but some degrees cooler. Walla 
Walla is typical of this region, Spokane is higher and 
farther north, and has a most agreeable summer; the 
region about Baker City is still higher, and cooler in sum- 
mer; but offers no accommodations to speak of. 

The North Pacific Region. Outside of the section near 
to and including Vancouver Island, the coast has nothing 
to offer the health seeker, as the climate is raw, though 
not really cold, throughout the year. The section men- 
tioned, however, offers fine and cool summer quarters 
at Victoria and New Westminster, far superior to what 
one would expect in this rather remote portion of the 
globe. 

The interior of British Columbia is terra incognita to 
the medical climatologist, chiefly because of its remote-, 
ness from our great centers of population. In the up- 



HEALTH RESORTS 167 

lands the climate is alpine, with moderate extremes of 
temperature and deep snow in winter, the summer being 
exceedingly pleasant and bracing. The lowlands vary 
greatly according to situation, for the amount of moisture 
declines rapidly as we approach the mountains, but the 
temperature is moderate everywhere, save for some hot 
days below Kamloops, and an occasional spell of zero 
weather in winter. I have already given the tabular 
data that are most trustworthy; they are here pre- 
sented in convenient form for the first time, and may 
encourage experimentation with this decidedly healthful 
region. 

Alaska is either too wet' or too cold for the health 
seeker, and need not detain us. For the "present there 
are no accommodations for travelers except aboard the 
tourist steamers, but certain classes of neurotic invalids 
may be benefited by the popular Alaska tour, on which 
storms are not likely to be troublesome, as the course of 
the steamers lies behind the islands along the coast. The 
best and least rainy season embraces June and July, 
sometimes August is also pleasant; at other seasons 
torrential and continued rains may be expected with 
certainty. 

A CLIMATIC CLASSIFICATION OF AMERICAN RESORTS 

There is some advantage in classifying the American 
resorts along the fines laid down in the first chapter; 
while necessarily somewhat of a jumble of heterogeneous 
elements, such a list will still be of use as a general guide. 

A. Hot and moist. The Florida Keys, the Bahamas, 
the West Indies. 

B. Warm and very, moist. The immediate coast from 



168 THE CLIMATIC TREATMENT OF CHILDREN 

Charleston, S. C, to the Rio Grande and beyond, the 
Bermudas. 

C. Warm and moderately moist. The inland strip imme- 
diately adjacent to the above, the remainder of Florida, 
southeastern Texas, southwestern coast of California. 

D. Warm and dry. Southwestern Texas, the Mexican 
Plateau, the hill country of southern California. 

E. Warm and desert-like. The arid belt from Phoenix, 
Ariz., to the San Bernardino Range in California. 

F. Very temperate and very moist. The California 
coast from Santa Barbara to San Francisco, also the 
islands off southwestern California, 

G. Very temperate and moderately moist. From the 
preceding inland to the Coast Range. 

H. Warm temperate and very moist. The Atlantic 
Coast from Cape Hatteras to Charleston. 

I. Warm temperate and moderately moist. The Gulf 
States except as noted in B and C, and the lowlands of 
South Carolina and southern North Carolina. 

J. Warm temperate and dry. The moderate elevations 
from central Texas to the Mojave Desert, the Great 
Valley of California. 

K. Middle temperate and very moist. The coast from 
Cape May to Cape Hatteras. 

L. Middle temperate and moderately moist. . The low- 
lands from St. Louis and Cincinnati to Memphis and 
Chattanooga; the Piedmont from Washington, D. C, to 
Charlotte, N. C, southern Missouri, Arkansas and 
Oklahoma. 

M. Middle temperate and dry. Southwestern localities 
between 3,000 and 4,500 feet. Very few stations come 
under this head. 



HEALTH RESORTS 169 

N. Cool temperate and very moist. The coast from 
Portland, Me., to Cape May. 

0. Cool temperate and moderately moist. The lowlands 
of New York and New England; Pennsylvania, except 
the highest hills; interior New Jersey; the southern 
Alleghanies up to 2,500-3,500 feet; the Lake Region 
from latitude 43.5 southward, thence to Cincinnati and 
St. Louis; the upper Mississippi Valley, South Dakota, 
Nebraska and Kansas to the 100th meridian; eastern 
Washington and Oregon up to 2,500-3,500 feet (the 
last are dry in summer). 

P. Cool temperate and dry. The Rocky Mountain 
Slope and Great Basin, the mountains themselves up to 
7,000 feet in the south and 3,000 feet in Montana, the 
lowlands of interior British Columbia. 

Q. Cool and very moist. The coast from Newfound- 
land to Portland, Me., and from San Francisco to 
Alaska. 

R. Cool and moderately moist. The upper Lake Region/ 
North Dakota, nearly all of Canada, the higher Alle- 
ghanies from 1,000 feet in New England to 3,500 in 
North Carolina, upward. 

S. Cool and dry. The higher Rocky Mountains to the 
tree line. 

T. Cold and very moist. Greenland and the Labrador 
coast. 

U. Cold and moderately moist. All the mountains 
above the tree line and subarctic Canada. 

FOREIGN RESORTS 

In considering foreign resorts no attempt will be 
made to cover the ground completely, but only such 



170 THE CLIMATIC TREATMENT OF CHILDREN 

regions will be dealt with as come within the ordinary 
scope of the American practitioner. Three groups inter- 
est us chiefly, namely, the coast of western Europe, the 
mountains of central Europe, and the Mediterranean 
Region. 

Western Europe.' Western Europe affords a wide 
range of moist climates, which are the mildest in the 
world for the latitude, with a. most even temperature, 
and certain conspicuous advantages even over our 
Pacific Coast. They all have the merit of being more 
conveniently accessible from our eastern cities, for, to 
only a passably good sailor, the transatlantic voyage is 
in many ways pleasanter than the four days' railway 
journey to the Pacific. Accommodations, furthermore, 
are almost universally excellent in western Europe; as 
much can be said only of certain especially popular 
resorts on our continent, the fare, in particular, being 
too often unsuitable to an invalid at places affording a 
most attractive climate. 

Norway and Sweden are known to Americans chiefly 
through the popular trip- to the North Cape, which in- 
volves a rather rough voyage that unfits it for delicate 
persons. The inland stations of this attractive section, 
almost ignored by the medical climatologists, afford a 
summer that is not very different from that of eastern 
Canada, cool and bracing, with some twenty hours of 
daylight, but perhaps a slight excess of moisture. The 
remoteness from fashionable life constitutes a valuable 
asset and makes one wish that this region be made the 
subject of further study. 

A few temperature data from this section will no 
doubt be welcome : 



HEALTH RESORTS 



171 





Feb. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Ar^^TTo,, $ Hammerfest .... 
Norway | Bergen 

Sweden — Stockholm 


23 
34 
26 


32 
42 
37 


53 

58 
62 


35 
45 

43 


35.4 
44.6 
41.5 


75 
79 

88 


6 
12 
-6 



Autumn is the rainiest season on the west coast of Nor- 
way, elsewhere most rain falls in summer. Bergen is 
one of the wettest stations, with 74 inches annually; 
but many parts of the interior of Norway and Sweden 
have less than 20 inches. The climate of Bergen is 
almost an exact reproduction of that of Sitka, Alaska, 
but Bergen is three degrees farther north, and about 
two degrees warmer. 

The British Isles. We find a wonderfully even climate 
on the western and southern coasts of Great Britain and 
Ireland, whereas the interior and eastern portions of 
Scotland and England present more variable and ex- 
treme conditions. We may begin by glancing at the 
temperatures for the five cold months at the most 
favored stations : 





Nov. 


Dec. 


Jan. 


Feb. 


Mar. 




48 
48 
47 
46 


45 
46 
44 

43 


45 
45 
43 

42 


45 
46 
44 

43 


46 




47 


Jersey, Channel Islands 

Ventnor, Isle of Wight 


45 

44 



These stations not only have the temperature of central 
Italy, but more sunshine than other points in Britain; 
the latter is not, however, saying a great deal, and 
Jersey, with 1,800 hours of sunshine per year, is still as 
cloudy as the south shore of Lake Ontario, and very far 
indeed behind the least sunny Mediterranean resorts. 



172 



THE CLIMATIC TREATMENT OF CHILDREN 



The minimum temperatures at these favored stations 
are remarkably mild. At Valentia the average annual 
minimum is 29 degrees, the record is 21; even for Vent- 
nor 26 is reported as the mean minimum, and the same 
figure applies to the Channel Islands. The vegetation 
of these sections is mixed with subtropical forms, origin- 
ally introduced, but now naturalized; snow is quite an 
exceptional phenomenon. 

The summer temperature of Great Britain and Ireland 
varies chiefly according to the latitude, but is a little 
higher on the east coasts and inland. It barely touches 
60 in interior Ireland or the south of Scotland in July, 
but reaches 61 to 62 in all the southern English counties, 
including the Channel coast and islands. In northern 
Scotland it drops to 56, and on the Shetland Islands to 53. 

Storminess is the main defect of the British climate, 
but from April to August the weather is relatively quiet. 
Fogs are exceedingly common, but not worse than on 
our extreme northeastern and northwestern coasts; the 
black fog of the English and Scottish cities is a local 
affair, as already explained. 

For the sake of completeness I give temperature data 
for the three capitals. 





Jan. 


Apr. 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Edinburgh 


37 
40 
37 


45 
47 
47 


58 
60 
62 


47 
50 
50 


46.8 
49.1 
49.1 


76 

87 




Dublin 


23 


London (Greenwich) 


17 



The absolute extremes at Greenwich for a very long 
period are 97 and 4 degrees. London has very nearly 
the climate of Seattle, but the summer is rainier, the wet 



HEALTH RESORTS 



173 



season also coming on somewhat earlier, and lasting from 
August to January, with a fairly dry spring. The east of 
England has only 24 to 30 inches of rain, falling on about 
180^ days, so that a drizzle is commoner than a heavy 
downpour; in the Scottish Highlands and in Cumber- 
land we find over 100 inches per annum, and in autumn 
these districts are fairly drowned in torrential rains. 

Save for the extreme south, Great Britain is only to 
be regarded as a summer resort, and even then, as just 
stated, there often is an excess of moisture. The spring 
is considered unwholesome, on account of the frequent 
east winds which, coming from the continent, are rela- 
tively dry; it is doubtful if they can be regarded as 
injurious to Americans, who are used to a drier climate. 
The average annual humidity in the center of England 
(Oxford) is 80 per cent., 86 in early winter, 74 in late 
spring; the last may seem dry to an Englishman, it cer- 
tainly would not give us that impression. 

The German Coasts. An abundance of climatological 
material is furnished from the coasts of Germany. 
Along the North Sea we have the following temperatures : 





Jan. 


April 


July 


Oct. 


Year 




34 
33 


43 
44 


62 
62 


51 
49 


47.3 


Sylt 


46 9 







The winter is colder than in Britain, the summer very 
slightly warmer; there is a good deal of very bad 
weather from October to April; 11 inches of rain, are 
spread over the winter and spring, and 16 over the sum- 
mer and autumn. 

The Baltic Coast is much colder in winter, but hardly 
warmer in summer : 



174 



THE CLIMATIC TREATMENT OF CHILDREN 





Jan. 


April 


July 


Oct. 


Year 


Putbus (Riigen) - 


31 
30 


42 
43 


63 
63 


47 
48 


45.5 
45.7 





The Baltic resorts are generally preferred by the Ger- 
mans, as there is practically no tide or surf; but the 
water is only brackish, not really salt. The winter cli- 
mate is decidedly gloomy, raw and disagreeable, but the 
summer is rather pleasanter than on the North Sea. 
More than a third of the precipitation falls in summer, 
the minimum is from January to April, about a fourth 
of the total in all; the autumn is much damper than the 
spring, as on all northern coasts. 

Americans rarely have occasion to visit these shores, 
as our own northeast affords a similar temperature with 
less storminess. 

The Atlantic Coast of France has quite a uniform cli- 
mate, in spite of the differences in latitude; the only 
general change from north to south is a decrease of 
cloudiness. We may begin with a table of tem- 
peratures and include therein the coast of the Nether- 
lands and Belgium, which is similar, though somewhat 
colder. 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 




36 
43 

45 


47 
52 
54 


63 
64 

67 


51 
54 

58 


49.2 
53.0 
55.8 


90 

98 




Brest 


24 
23 







Note that the minima are lower at Biarritz than at Brest. 
The former place is, all in all, perhaps the best on the 
French coast, being relatively sunny and not very 



HEALTH RESORTS 



175 



stormy. The distribution of rainfall is pretty uniform 
on these coasts, but with a slight excess from September 
to 'January, and a moderate summer minimum south- 
ward; the total exceeds 70 inches in the southwest 
corner. The relative humidity is high, 76 per cent, in 
spring and 83 in autumn, in spite of occasional dry and 
warm "foehn" winds. 

To complete the picture, I give a few temperature 
data from the interior of France: 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Paris (suburban) 


36 
36 


49 
53 


65 
70 


50 
53 


50.2 
52.7 


93 


12 







In central France some 30 inches of rain are quite 
evenly distributed through the year" save for a slight 
minimum in March and maximum in May. Tempera- 
tures above 95 and near zero are not so very rare. 

The North and West Coasts of Spain and Portugal have 
a climate something like that of our Pacific Coast. Along 
the. Bay of Biscay we are reminded of southern Oregon, 
farther south the south California coast ie recalled, so 
great is the similarity in almost every detail, as to both 
temperature and the distribution of moisture. 

The following table will suffice to indicate the tem- 
perature of this section: 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Oviedo (700 feet) 

Lisbon 


43 
51 


54 

58 


66 
71 


56 
62 


54.5 
60.1 


91 
96 


25 
35 



176 



THE CLIMATIC TREATMENT OF CHILDREN 



Lisbon closely resembles Los Angeles, but is somewhat 
moister, with less intense hot winds in summer: 29 
inches of rain fall annually, 12 in winter and only 1.5 in 
summer. At Oviedo 36 inches fall in the course of the 
year, 13 in winter and 4 in summer; here it snows a few 
times nearly every winter, whereas in Portugal snow is 
very rare in the lowlands. 

It is a pity that accommodations in Portugal should 
be generally so primitive as to bar out health seekers 
from perhaps the finest all around winter climate in 
Europe. 

The Azores and Madeira. Here the Portuguese type 
of climate is intensified, and the variations of tempera- 
ture become very small, as shown in this table : 





Jan. 


April 


July 


Oct. 


Year. 


Average 




Max. 


Min. 




57 
60 


59 

62 


71 

72 


65 

68 


63.0 
65.5 


80 

85 


43 




49 







Frost is unknown in the lowlands, and the absolute 
minimum at Madeira is 44 degrees, 91 being the record 
in summer; visitors complain of the hot winds, but 
they cannot be unbearable under the circumstances, 
especially as they are notoriously dry. 

The Azores are too windy to be ideal for many pa- 
tients, and both groups are decidedly enervating, except 
from October to May. On the Azores we find 36 inches 
of rain, 13 in winter and 4 in summer; on Madeira 27 
inches, 13 in winter and none from May to September. 
Madeira has a remarkably low humidity, 65 to 70 per 
cent, throughout the year; the proportion of cloudiness 
is also moderate, and fogs are not very common. 

The Pyrenees. The Pyrenees are most conveniently 



HEALTH RESORTS 177 

considered here, though their climate resembles that of 
central Europe in many respects. Only the French side 
offers a sufficiency of good accommodations; the south- 
ern slope, which probably affords a better winter climate, 
is relatively undeveloped, though some mineral springs 
of the first rank are to be found there. Unfortunately 
we have but few climatic data from this region ; Pau, at 
700 feet, has a mean January temperature of 42 degrees, 
with an average minimum of 20; the humidity is about 
ten per cent, lower than at Biarritz. The rainfall in this 
region ranges from 50 to 80 inches, with maxima in 
spring and autumn. 

It will be seen, from the above, that the French 
Pyrenean climate is cool and moist in winter, mild and 
often very wet in spring and autumn; the Spanish side 
is much drier, and among the foothills, quite extreme. 
I have not been able to find any thermometric data for 
the summer, but the average for July, at 1,500 feet, is 
about 68 degrees in the west, rising gradually eastward 
to about 72 near the Mediterranean; the latter section is 
very little visited, compared to the region about Pau and 
Tarbes. 

Central Europe. The hill and mountain country of 
central Europe has deservedly become the world's 
favorite playground and health resort. Its natural ad- 
vantages, only in part climatic, have been enhanced by 
artificial improvements and no little governmental aid, 
and the visitor is made comfortable in ways of which 
American resort boomers know only the veriest rudi- 
ments. Excellent roads, shady and smooth paths, 
cleanliness and good food at all prices, first-rate medical 



178 



THE CLIMATIC TREATMENT OF CHILDREN 



attendance, and a most ingenious development of every 
little factor that can contribute to health and enjoyment, 
have been held out to the traveler in the most tempting 
way. 

South and Middle Germany consist almost wholly of 
country resembling our Alleghanies; mountains from 
three to five thousand feet in height alternate with pleas- 
ant river valleys and interesting old towns. The climate 
is similar to that of our northeastern hills, but is a little 
cooler in summer, and decidedly milder, though more 
cloudy, in winter. I give a short table: 





Elev. 


Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Harz Mountains... . 
Black Forest 


2,300 
2,600 


27 
28 


39 

43 


57 
60 


44 
44 


41.5 
43.6 


86 

86 


-4 
-5 


Some of the chief towns of Germany are given here 
for comparison: 




Elev. 


Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Berlin (suburban) . 

Frankfort a. M 

Munich 


150 

300 

1,750 


31 
32 

27 


46 
49 
45 


65 
66 
63 


48 
49 
46 


47.3 
48.6 
45.0 


91 
92 

87 


2 

4 

-1 



Note the cool and rather extreme climate on the Bava- 
rian plateau (Munich); in marked contrast thereto is 
the high temperature of the upper Rhine Valley: 





Elev. 
400 


Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Heidelberg.- 


34 


50 


66 


50 


49.8 


91 


6. 



The rainfall in South Germany ranges from 25 inches 
on the upper Rhine to over 50 in the mountains; one- 
third falls in summer, half as much in winter, with the 
other seasons exactly intermediate. The colder sections 



HEALTH RESORTS 



179 



are usually covered with snow for two or three months, 
in the warmer localities the snow covering is inter- 
mittent, because of the high mean temperature; the win- 
ters vary exceedingly in this respect. 

Save for the successful treatment of tuberculosis at 
Goerbersdorf (1,800 feet), Silesia is almost unknown to 
American climatologists. The mean temperature at 
this resort is 28 degrees in January, 42 in April, 61 in 
July, and 44 in October, the year averaging 43.4. The 
climate is therefore much milder than in the Adirondacks 
at the same level, except during the summer, when it is a 
few degrees cooler. On rare occasions, the thermometer 
falls as low as —20 in the Silesian hills; it rarely rises 
above 90. The distribution of moisture is exactly the 
same as in western Germany. 

Bohemia has a number of very excellent and popular 
resorts in its northwestern parts. The representative 
town of Carlsbad (1,200 feet) has the following tem- 
perature: • . 

January, 28; April, 46; July, 65; October, 47; year, 45.7 degrees. 

The distribution of moisture remains the same as for 
Germany. 

The Northern Slopes of the Alps have similar tempera- 
tures, save in certain valleys trending northward, where 
the colder months, as at Altdorf, are materially warmed 
by descending foehn winds; the following table gives a 
few data : 





Elev. 


Jan. 


April 


July 


1 


Average 






Max. 


Min. 


Zurich, Switzerland 

Altdorf, " 


1,550 

1,500 

2,000 

750 


29 
32 
26 
29 


48 
49 
48 
49 


65 
64 
64 
67 


47 47.3 
49 ! 48.4 

49 46 . 4 

50 48 A 


87 
86 

92 


7 
12 


Innsbruck, Austria ; 

Vienna (suburban), Austria. 


6 



180 



THE CLIMATIC TREATMENT OF CHILDREN 



The distribution of rain is the same as in south Ger- 
many, with a slight increase in summer, and decrease in 
winter. 

The Alpine Plateau, being shut in by mountains, does 
not obtain the benefit of the inversion of temperature in 
winter that characterizes the peaks and their slopes; its 
temperature is therefore low throughout the year. The 
winter resembles that in the Adirondacks, but is not 
quite so cold or nearly so changeable, and temperatures 
under —20 are quite rare. The summer is cold, almost 
arctic, with occasional frost and even snow; the weather 
at that season is, in fact, altogether autumnal, and by the 
end of October winter resumes its sway. The worst 
month in this region is April, when the accumulated 
snow of winter melts with some rapidity. 

The following table gives the temperature at some 
well-known resorts: 





Elev. 


Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Davos, Switzerland, . . 
St. Moritz, " ■'. ". . 
Upper Tyrol, Austria . . 


5,300 
5,900 
4,800 


19 

17 
19 


36 
33 
36 


54 

. 52 

53 


38 
36 
38 


36.7 
34.7 
36.4 


72 


-8 



The humidity at Davos is 82 per cent, in winter, and 74 
in spring and summer, and the climate is therefore quite 
moist, even more so than that of our northeastern moun- 
tains. Two-fifths of the precipitation fall in summer, 
only one-sixth in winter; the total snowfall amounts to 
about ten feet. 

The Southern Slope of the Alps, sheltered by the excep- 
tionally steep declivity to the north, is relatively very 
mild, milder than the lowlands of northern Italy. This 
region affords some of the most desirable spring and 



HEALTH RESORTS 



181 



autumn resorts in the world, and even in winter the 
sheltered situation of these retreats gives them a high 
rank. The average temperature of this section some- 
what resembles that of the southern Alleghanies, but 
the weather is far less changeable, and zero is almost 
unknown. The following tables will furnish very ample 
details : 





Elev. 


Jan. 


April 


July 


Oct, 


Year 


Average 




Max. 


Min. 


Montreux, Switzerland . . : . . 

Lugano, 

Meran, Austria. 


1,300 
900 

1,100 
300 


33 
34 
33 
37 


49 
52 
55 
55 


67 
71 
73 
74 


50 
53 
54 
57 


50.2 
52.3 
53.6 
55.4 


83 
89 
91 


15 
20 
17 
23 







Pallanza, on Lake Maggiore, has a mean temperature of 
37 degrees in January, and Bellagio, on Lake Como, 
averages 38; the respective minima are 21 and 22; 
the lowest temperature at Lugano in fifteen years was 
12 degrees; in summer temperatures over 90 are quite 
common on the Italian lakes. The monthly range at 
Meran, in winter, is only 30 degrees, the same as at 
Cannes, and 6 less than at Pau. This region, therefore, 
affords a rare example of a moderately cold but very 
steady winter, in which it differs strikingly from any- 
thing known in the United States. 

Before leaving the Alpine region, we may review a 
few general matters. Zurich and Berne have only 1,760 
hours of sunshine annually (40 per cent.)*, Montreux, on 
the southern slope, has 1,930 (44 per cent.), and Lugano 
2,250 (50 per cent.). In January the sun shines four 
hours per day at Lugano and only eighty minutes at 
Zurich ; in July the respective figures are nine and a half 
and eight. The plateau makes a better showing in 
winter than the northern slope, for Davos has a daily 



182 THE CLIMATIC TREATMENT OF CHILDREN 

allowance of three hours in January; in summer, how- 
ever, the proportion of cloudiness is a trifle higher on 
the plateau. 

The distribution of rain on the southern slope of the 
Alps is no longer exactly the same as farther north; the 
amount is relatively great, for the warm southerly 
winds condense their moisture on striking the mountain 
wall. Of the average total of about fifty inches, 15 fall 
in summer, and the same in autumn, only 8 in winter. 
The autumn rains are the first step in the transition to 
the Mediterranean region, where heavy October and 
November rains prevail throughout. 

In closing our survey of this section we must not fail 
to call attention to the accessibility of the hundreds of 
good resorts within this region, and the universally 
excellent accommodations " to fit every purse. In the 
latter respect it is to be regretted that American enter- 
prise has hitherto proved sadly remiss; single cantons 
of Switzerland contain more good hotels than the whole 
Alleghany Mountain region, and the accommodations 
offered in this country to persons of. moderate means are 
usually inferior, the table especially being unsuited to 
individuals whose health is impaired. Another 'defect 
.of American resorts is the absence of good paths, with 
easy grades, and in most cases, good roads for driving. 
The author, having an intimate personal knowledge of 
the mountain resorts on both sides of the Atlantic, 
experiences no feeling of astonishment at the enormous 
annual exodus of American tourists and invalids to 
the health resorts of Europe; the trials of the ocean 
voyage are more than compensated by the better care 
obtainable on arrival. 



HEALTH RESORTS 183 

One of the defects of the climate of central Europe is 
the variability of the seasons, which equals that in the 
Rocky Mountains, and makes it impossible to promise 
the visitor anything like the normal conditions. Espe- 
cially is this the case in winter,. when the weather in the 
Rhine Valley, for example, may be as cold as at St. 
Petersburg or as warm as at Florence. Meanwhile the 
daily variability is barely one-half of that in the eastern 
United States; here the advantages of the European 
climate are conspicuous, sudden changes are indeed rare ; 
a change of 20 degrees from day to day occurs only 
once in three winters in central Europe, six times in each 
winter in the eastern United States,' and oftener in the 
middle West. 

Throughout central Europe the percentage of humidity 
is about 80 to 85 in winter, and 65 to 75 in summer; it is 
always low during the infrequent hot spells, when the 
daily range, even in the cities, exceeds 30 degrees. The 
nights are therefore cool in the warmest weather, a 
minimum as high as 70 degrees being phenomenal, 
whereas this is the July average in the warmer American 
cities. Heat-stroke is therefore very rare in central 
Europe ; though the maximum temperatures differ but 
slightly from ours. 

The Mediterranean Region. Here, we begin the study 
of a territory that offers a range of climatic attractions 
unrivaled on the globe. Only a small strip of North 
American soil, two to three thousand miles from our 
great centers of population, has a climate of similar type, 
and for extent, variety, luxuriance of vegetation, and 
facilities for the traveler, the most favored Mediterranean 



184 



THE CLIMATIC TREATMENT OF CHILDREN 



resorts have a rival only in one small corner of our 
Pacific Coast, embracing at the most 10,000 square miles, 
just equal in area to Sicily. 

Spain. But for generally primitive conditions, the 
Mediterranean shores of Spain would rank high among 
health resorts; as matters stand, only Gibraltar and 
Malaga can be recommended. Valencia and Barcelona 
also afford a pleasant winter climate, but the health 
seeker is treated better at other places that are quite as 
salubrious. We may glance at the following data of 
temperature : 





Jan. 


April 

• 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Gibraltar 

Malaga 


54 

54 


61 
61 


74 
79 


65 
66 


63.5 
64.6 


93 
105 


38 
36 



Frost is rare at Gibraltar and Malaga, but temperatures 
as low as 20 degrees may occur on the east coast. The 
hot winds of summer are as trying as in California, 
including also the dust and a very low humidity; the 
absolute maxima range from 110 to 114 degrees. At 
Gibraltar the influence of the Atlantic Ocean begins to 
be felt; the summer heat is mitigated by sea breezes, 
and the maxima rarely approach 100. 

Valencia has 260 clear days in the year; the proportion 
of cloudiness falls below 15 per cent, in midsummer. 
The summer is almost rainless everywhere, and most of 
the east coast suffers from drought at all seasons. 

Malaga is at its best from November until May, it is 
far too warm from June until October ; accommodations 
there are fairly good, and the place is gaining a very 
favorable reputation as a resort for the winter and early 
spring. 



HEALTH RESORTS 



185 



The interior of Spain has an extreme continental cli- 
mate, resembling that of our Rocky Mountain plateau. 
We may glance at the following table : 





Elev. 


Jan. 


April 


July 


Oct. 


Year 


Average 




'Max. Min. 


Madrid 

Valladolid 


2,150 
2,500 


40 
37 


54 
52 


75 
70 


55 
52 


55.0 
53.0 


103 
101 


17 
13 



The absolute extremes for ten years at Valladolid were 
110 and -6. 

Madrid has only 16 inches of precipitation annually, 
of which only two fall in summer, and the remainder are 
pretty evenly distributed through the year, with a slight 
maximum in May; Valladolid is almost desert-like, with 
12 inches annually. In Madrid the humidity in July 
falls to 44 per cent, and the cloudiness to 19; the winter 
is fairly damp and cloudy, as is usual in similar situations 
in this latitude. There is plenty of frost in winter, but 
the amount of snow is moderate; the total sunshine for 
the year is 2,930 hours (70 per cent.), about the same as 
at Salt Lake City, which has almost exactly the same 
climate in other respects, save for a decidedly colder 
winter. 

■ Mediterranean France resembles eastern Spain, but 
the winter is slightly colder ; the Riviera is different and 
quite anomalous. In winter the icy mistral blows on two 
days out of three, bringing zero weather almost to the 
coast. Temperatures follow : 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 




42 
44 


55. 
55 


74 
72 


58 
60 


57.4 
57.8 


99 


15 











186 THE CLIMATIC TREATMENT OF CHILDREN 

The mistral is most violent at Avignon, where it is 
powerful enough to upset railway trains, and all the 
trees are bent over southwards. 1 The precipitation is 
exceedingly small at all seasons, 20 inches per annum 
at Marseilles, of which 3 fall in summer and 7 in autumn 
Snow is not very common, for the sky is almost always 
clear when the mistral blows; the temperature on these 
occasions has fallen to zero as far south as Avignon. 

This climate is little better as to temperature than 
our Middle Atlantic Coast, and worse as regards high 
cold winds, which is saying a very great deal. Our own 
northwesters rarely exceed sixty miles per hour, a rate 
undoubtedly surpassed in southeastern France, where 
these gales are also more frequent. The region cannot 
be recommended to any save the very robust, and the 
contrast to the Riviera, lying immediately to the east- 
ward/ is far greater than shown by the average thermo- 
metric figures. 

The Riviera. The remarkable strip of coast known as 
the Riviera is usually regarded as extending from Hyeres 
to Leghorn, Genoa being the dividing point between 
its western and eastern portions. This region owes its 
phenomenally mild winter, in the latitude of northern 
New York, to the wind shelter afforded by the Maritime 
Alps and the Apennines; these mountains, however, rise 
immediately from the shore only from Nice to Spezia, 
the outer ends of the Riviera being less sheltered; we 
have therefore presented to us the anomaly of colder 
winters in the more southerly portions, and the greatest 
mildness at the center of the arch, lying farthest north- 
ward. At the western end the mistral still blows with 

^Hann, vol. TTI., p. 47. 



HEALTH RESORTS 



187 



some frequency and violence ; Leghorn, also, is somewhat 
exposed to cold north winds; the intermediate parts 
are sheltered, and when the north winds are felt at all, 
they are dynamically warmed by their descent to the 
sea. 

Unfortunately but few accurate temperature data are 
available ; those extant are here given : 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Nice (C) 


47 
45 
44 


58 
57 
56 


75 
75 
75 


63 
62 
61 


60.3 
59.4 
58.5 


88 


30 


Genoa (C) . . . . '. 













Temperatures below 25 degrees are exceedingly rare, 
but it is evident that the winter is not nearly so mild as 
in southern Spain or southwestern California. Snow 
falls once or twice in each winter, but prolonged spells 
of bad weather are uncommon; we must not fail to note, 
however, that the rainfall gradually increases as we 
advance eastward into Liguria and Tuscany; the per- 
centage of cloudiness also rises, though the majority of 
the winter days are still pleasant. Even aside from the 
superiority of the accommodations, the western Riviera 
is therefore preferable to the eastern portion. 

In spite of its warmth, the summer on the Riviera is 
rather free from malaria, in marked contrast to places 
farther south having the same temperature; this differ- 
ence is unquestionably due to the absence of marshes, 
and is an advantageous feature for such persons as require 
a mild climate in the late spring or early autumn; Octo- 
ber is quite a safe and pleasant month on the Riviera, 
whereas it is rather dangerous even a short distance 
farther south or inland. 



188 



THE CLIMATIC TREATMENT OF CHILDREN 



The Po Valley. Most startling is the change in winter, 
on crossing the Apennines from Genoa to Turin; Ales- 
sandria, only 300 feet above sea level, and forty miles 
from Genoa, is 14 degrees colder in January on the aver- 
age, but during cold spells as much as 25 degrees, for the 
temperature may fall below zero. In a modified degree,, 
this relative coldness extends eastward to the Adriatic, 
but diminishes northward, toward the Alps, where the 
lake resorts have a much milder winter, .with minima not 
nearly so low as on the plain. The summer does not 
differ materially from that of. the Riviera, being in fact 
rather hot for the latitude. Temperature tables follow: 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Milan (C) 


32 
36 


54 
54 


75 
75 


55 

58 

» 


53.8 
55.0 


94 


12 


Venice (C) ." 









Only the spring may be safely recommended in this sec- 
tion; the winter is rather cold and somewhat changeable, 
with a good deal of cloudiness; the summer and early 
autumn are very malarious, and the late fall is un- 
pleasantly wet. Of about 32 inches of rain 10 fall in 
autumn and 8 in spring, a trifle less in summer and over 
6 in winter; the distribution is therefore not very uneven. 
October is the wettest month. Heavy snow is common 
from December to February, and may lie on the ground 
for weeks at a time. 

The Italian Peninsula. Here we encounter a gradual 
increase of warmth as we go south, but the temperature 
of the Riviera is not reached until we come to the 41st 
parallel, north of which the vegetation of the warm 
temperate zone is but feebly developed. In the moun- 
tainous interior the climate, of course, is colder, and the 



HEALTH RESORTS 



189 



country is more or less liable to be snowed up in winter 
as far as Calabria. There is no great difference, in win- 
ter, between the western and eastern shores of the 
peninsula, but in summer the Adriatic Coast is consider- 
ably warmer, though perhaps not so unhealthy, marshes 
being less frequent and extensive. The temperature is 
as follows : 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Florence (C) 


41 
44 
47 


57 
57 
57 


76 
75 

76 


59 
62 
63 


58.3 
59.5 
60.6 


95 




Rome (C) 


26 


Naples (C) 









This section, also, is at its best during the spring;' the 
winter is not very mild north of Naples, and the summer 
and autumn, outside of the great cities, are rendered very 
dangerous by malaria. 

Of 33 inches of rain, 11 fall in autumn, 9 in winter, 8 
in spring, and only 5 in summer. At the last season the 
humidity falls to 58 per cent., with hot days and nights 
that are fairly comfortable if the ubiquitous mosquito 
be excluded. ■ The proportion of clouds at Rome ranges 
from 50 per cent, in winter to 25 in summer, so that 
Italy has- a sky no clearer than that of much of the 
United States. The amount of sunshine ranges from 
2,200 hours in Piedmont to 2,600 and more in the 
south. 

The Mediterranean Islands. Of the islands in the 
western Mediterranean Sea we need consider only 
Corsica, Sicily and Malta; Sardinia and the other islands 
are in too backward a state to offer good accommoda- 
tions to health seekers. 

The following table gives an idea of the temperature : 



190 



THE CLIMATIC TREATMENT OF CHILDREN 





Jan. 


April 


. July 


Oct. 


Year 


Average 




Max. 


Min. 


Ajaccio (Corsica) 

Palermo (Sicily) 

Malta •. 


49 
51 
54 


57 
59 
59 


77 
77 

77 


66 
67 
69 


62.6 
63.5 
64.0 


103 
96 


35 

42 



The winter becomes wonderfully mild as we go south, 
but even Corsica is perhaps the warmest place in the 
world for the latitude; frost and snow are uncommon 
everywhere, except in the mountains, and are practically 
unknown in Malta; we may note that Corsica is as far 
north as Massachusetts, and Sicily in a line with Virginia. 
The *best season extends from November until April; 
even May is cooler than October, when the weather is 
still quite hot and malignant forms of malaria are rife. 
In' Sicily and Malta there is only about half an inch of 
rain for the entire summer, whereas 16 inches fall between 
October and January, and 5 more in February and 
March. The humidity rarely falls, as low as on the 
Italian peninsula, 60 per cent, in July being the lowest 
in Palermo and Syracuse. At such places, however, as 
Palermo, it falls to desert-like figures when a sirocco 
runs the temperature up to 105 to 115 degrees in the 
shade. 

1 stria and Dalmatia. The Adriatic coast of Austria- 
Hungary somewhat resembles the Riviera, but it lies 
farther north, is decidedly colder in winter, and nowhere 
free from the terrific northeast wind (bora) that resem- 
bles the mistral of southern France. The east shore of 
the Adriatic is, however, very much warmer in winter 
than the Italian side, for the bora, though keen and cold, 
is still warmed considerably in descending from the Alps; 
in addition warm and moist winds from the Adriatic are 



HEALTH RESORTS 



191 



frequent, raising the temperature in the cold season and 
tempering the heat in summer. 
The following table gives some thermometric data: 





Jan. 


April 


July 


Oct. 


Year 


Average 


• 


Max. 


Min. 


Treste 


39 
41 

48 


54 
54 

58 


74 
73 

77 


59 

58 
65 


55.9 
56.1 
61.9 


91 

91 
91 


21 


Fiume (Abbazia) 


24 

31 







The lowest temperatures for fifteen years were 14 
degrees at Trieste, 16 at Fiume, and 21 at Ragusa. At 
Fiume there are 60 inches of precipitation, of which half 
falls from September to January, and the other half is 
well distributed over the other seven months. At 
Ragusa there are 65 inches of rain, Of which 27 fall from 
October to December and only 8 in summer. Snow is 
fairly common northward, falling in blizzard-like storms, 
but becomes infrequent toward the south. In sum- 
mer and autumn the moist sirocco is very oppressive, 
resembling the warm and damp sea-breezes of our South 
Atlantic Coast. It may be said, briefly, that the suitable- 
ness of this region for invalids is similar to that of the 
Italian peninsula, but the bora must be avoided as far 
as possible by a careful choice of location, e.g., at Ab- 
bazia, and the summer is malarious at many places. 

Greece. In Greece only Corfu and Athens have any 
interest for us, the remainder being excluded by the 
semibarbarous conditions still prevailing in most places. 
This country, in the lowlands, has a mild but somewhat 
changeable winter and spring and intense heat and 
drought after the first of June. Corfu has about 50 
inches of rain, but only about 4 of them fell in summer, 
and the small allowance of 15 inches at Athens is con- 



192 



THE CLIMATIC TREATMENT OF CHILDREN 



centrated on the period from October to March (12 
inches) ; the proportion of clouds at Athens is similar to 
that of interior California; indeed, these two regions 
resemble each other greatly in almost every climatic 
detail. The temperatures for Greece are as follows: 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 


Corfu 


49 

47 


59 
59 


78 
81 


67 
66 


63.0 
63.1 


95 
101 


34 




29 







Snow is very rare at Corfu, but falls nearly every winter 
at Athens. 

Algeria: Algeria offers a number of good resorts, but 
Americans have hardly begun to familiarize themselves 
with this region, which presents every climate of our 
Southwest, except the cool and foggy summer of the 
immediate Pacific Coast. The following data indicate 
the temperature : 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 




53 

51 


60 
67 


76 
89 


66 

68 


63.3 
68.5 


99 
113 


38 


Biskra 


32 







Biskra lies at the edge of the Sahara desert, and has a 
climate very much like that of Phoenix, Arizona; the 8 
inches of rain fall chiefly in spring and fall, but there are 
some summer showers; otherwise inland Algeria has a 
rainy season from October to March (80%) and a dry one 
from April to September (20%); in the city of Algiers 
12 inches fall in winter, and only one in summer. 

Algiers is pre-eminently a winter resort on the coast 
and in the desert, and a spring resort in the mountain^, 
where deep snows are not rare from December to March, 



HEALTH RESORTS 



193 



and the temperature often falls far below the freezing 
point. [ 

Egypt, except in the lower Delta, has a dry climate, 
which becomes absolutely desert-like as we go south- 
ward. I shall begin by giving a few thermometric data: 





Jan. 


April 


July 


Oct. 


Year 


Ave 


RAGE 




Max. 


Min. 




58 
53 
59 


66 
70 

78 


79 

84 
92 


75 
73 
79 


69.1 
70.3 
77.0 


99 
109 
115 


45 




36 




.40 







At Alexandria the summer heat is mitigated by steady 
north winds from the Mediterranean; in autumn these 
often fail, and October is therefore about as warm as 
June; the hottest weather of the year usually occurs in 
September or October. The humidity is 66 per cent, in 
January, and 76 in July; no rain falls from March to 
September, ten inches during the remainder of the year. 

At Cairo it only rains an inch or two (in winter), and 
farther south rain is a curiosity; the humidity is still not 
so very low at Cairo, 61 per cent, for the year, and 45 in 
May, but in the deserts of upper Egypt the proportion 
of moisture is only about half as much, and the same as 
in our own southwestern deserts. Cairo has 30 per cent, 
of clouds in January and only 8 in June. 

Upper Egypt is tolerable only in winter, Cairo from 
November to March; accommodations are becoming 
first-rate. In every case an intermediate station should 
tide over the season of early spring, before returning 
home. 

Syria and Palestine. It is easy to foresee that these 
regions will soon be drawn upon as health resorts, for 
accommodations are improving rapidly, and a number 



194 



THE CLIMATIC TREATMENT OF CHILDREN 



of stations are becoming quite accessible. I give" tern 
peratures from Beirut and Jerusalem: 





Jan. 


April 


July 


Oct. 


Year 


Average 




Max. 


Min. 




55 

47 


65 
60 


81' 
76 


75 

69 


68.7 
62.8 


95 
102 


39 


Jerusalem (2,500 feet). . . 


32 



Beirut is too hot but very dry from April until November, 
Jerusalem from May to October; at the latter place the 
absolute range of temperature is from 112 to 25 degrees, 
there are 17 inches of rain in the cool months, and not a 
drop falls from the middle of May to the middle of 
October. There is some snow in most winters, but it 
rarely remains long on the ground. 



A CLASSIFIED LIST OF FOREIGN RESORTS 
CLASSIFICATION BY CLIMATE 

A. Warm and moderately moist. Madeira, the Azores; 
the Mediterranean islands, the Algerian coast, the south 
coast of Spain, southern Portugal, the coasts of Egypt 
and Syria. 

B. Warm and dry. The Algerian Sahara, lower Egypt 
away from the the coast. 

C. Warm and desert-like. Upper Egypt. 

D. Very temperate and moderately moist. ' The coast of 
northern Portugal. 

E. Warm temperate and moderately moist. The Riviera, 
southern Italy, Dalmatia, Greece, inland Algeria, the 
coast of Asia Minor. 

F. Warm temperate and dry. The Spanish plateau 
(lower levels), interior Palestine. 

G. Middle temperate and moderately moist. The south- 



HEALTH RESORTS 195 

east of France (except the Riviera), central and northern 
Italy, Istria and southern Tyrol. 

H. Middle temperate and dry. The Spanish plateau 
(higher levels). 

/. Cool temperate and moderately moist. The remainder 
of central and southern France (excepr the mountainous 
regions), the cooler resorts south of the Alps, the middle 
Course of the Danube, beginning near Vienna. 

J. Cool and very moist. The coasts from northern 
Spain to the North Cape. 

K. Cool and moderately moist. Inland western and 
central Europe. (More than half of Europe,' outside of 
Russia, belongs to groups J and K). 

CLASSIFICATION BY COUNTRIES 

A. Western Europe 

England. On the south coast, from west to east: 
Penzance, Salcombe, Torquay, Teignmouth, Exmouth, 
Sidmouth, Bournemouth, Ventnor, Brighton, Hastings, 
Folkestone, Dover; also the Channel Islands. 

Netherlands. Scheveningen, Flushing (Vliessingen). 

Belgium. Heyst, Ostende, Blankenberghe. 

France. Dunkirk, Calais, Boulogne, Treport, Dieppe, 
Fecamp, Trouville, Cherbourg and St. Malo on the Eng- 
lish Channel (except the first two on the North Sea); 
Brest, Les Sables d'Olonne, Arcachon and Biarritz on 
the Bay of Biscay; Vichy near the center; Plombieres 
in the Vosges Mountains; Pau, Tarbes, Eaux-Bonnes, 
Luchon and Bareges (4,000 feet) in the Pyrenees, the 
last three with warm sulphur baths; Aix-les-Bains 
(sulphur springs), Anhecy and Evian-les-Bains on 



196 THE CLIMATIC TREATMENT OF CHILDREN 

subalpine lakes; Chamonix (3,400 feet) in the high -Alps. 
Spain. San Sebastian on the Bay of Biscay. 

B. Central Europe 

Germany. Norderney, Helgoland and Sylt, islands in 
the North Sea; Riigen, Usedom and Wollin, islands off 
the Baltic Coast; Harzburg and Blankenberg in the 
Harz Mountains; Gorbersdorf (for tuberculous subjects) 
in Silesia; Aix-la-Chapelle (Aachen), with sulphur baths, 
in the northwest; Ems, Wiesbaden, Homburg, Wil- 
dungen, Nauheim 1 and Kreuznach 1 in the hill section 
from Mayence to Cassel; Oeynhausen 1 near Hanover; 
Baden-Baden, St. Blasien, etc., in the Black Forest; 
Kissingen in northern Bavaria ; Reichenhall 1 and Berch- 
tesgaden in the Bavarian Alps. 

Austria. Carlsbad, Marienbad, Franzensbad and Tep- 
litz in Bohemia; Innsbruck, Salzburg, Ischl, Hall 1 and 
the Dolomite Region on the north slope of the Alps; 
Meran on the southern slope; Riva on Lake Garda. 

Switzerland. Montreux and Ouchy on the Lake of 
Geneva; Lucerne, Brienz and Interlaken on the central 
lakes; Grindelwald, Murren, Davos, St. Moritz, Pon- 
tresina, Zermatt, and a host of others at elevations from 
3,500 to 5,500 feet; Lugano and BeUinzona on the 
southern slope of the Alps.. 

Italy (Lake Region). Pallanza, Stresa, Menaggio and 
Bellagio on Lakes Maggiore and Como. 

C. Southern Europe 

Spain. Malaga. 

The Riviera. Hyeres, Cannes, Nice and Mentone in 
1 Brine baths; see page 360. 



HEALTH RESORTS 197 

France; San Remo, Bordighera, Nervi, Spezia and Leg- 
horn in Italy. 

Italy {Peninsula). Pisa, Florence, Rome; Ischia, 
Capri, Sorrento and Castellammare near Naples; Paler- 
mo, Catania and Taormina in Sicily. 

Austria-Hungary. Abbazia, Pola, Lesina and Ragusa 
on the Adriatic. 

SEA VOYAGES 

Our foregoing review of climates and health resorts, 
though it has included some oceanic islands, still requires 
a few remarks concerning conditions on the high seas, 
and their utilization, if we wish our account to be com- 
plete ; this leads to the discussion of treatment by means 
of ocean voyages, freely recommended some years ago 
to chronic invalids, including children, notwithstanding 
that the attendant discomforts were even greater then 
than now. Recent times have witnessed a great dim- 
inution of some of the. disagreeable features of ocean 
travel, yet the enthusiasm for this method of climato- 
therapy has fallen off considerably. Much of this abate- 
ment of interest is due to a better knowledge of our 
resources on shore, but more is attributable to a recogni- 
tion of the inherent defects of the sea-voyage treatment, 
which are so serious as often to more than neutralize its 
undoubtedly good features. 

In detailing the merits of this method we cannot do 
better than to follow Weber, 1 taking them up seriatim, 
and noting the corresponding objections one by one, as 
we go on. 

The first benefit derived, and the most obvious, is the 
1 British Medical Journal, June 3, 1899. 



198 THE CLIMATIC TREATMENT OF CHILDREN 

opportunity to breathe a really pure and germ-free air, 
to be found elsewhere only on the highest mountain tops 
and in the arctic wilderness; to this purity there is 
added a trace of salinity,. Which has also been considered 
of some therapeutic value, possibly without any real 
reason. Against this positively good point we must set 
the usually decidedly foul atmosphere of the saloon and 
cabins, particularly aboard small ships and in stormy 
weather, when the hatches are closed. As life on deck, 
the main object of the voyage, is almost impossible when 
the sea is rough, the passenger may be compelled to 
spend whole days under not very wholesome conditions. 

Secondly, Weber refers to the even temperature at sea; 
this does not, however, obtain universally by any means, 
for the northwestern portions of the Atlantic Ocean, for 
example, are known to experience rather wide fluctua- 
tions during the colder months. Relatively speaking, 
however, Weber's statement may be accepted'; on the 
tropical and subtropical seas the temperature is indeed 
exceedingly uniform, and rather high, ranging almost 
all the time between 70 and 80 degrees. Such even 
warmth is, of course, very enervating, as Weber himself 
admits; in the belt of trade winds there is some compen- 
sation in the way of almost uninterrupted fine weather 
with fresh breezes, but in the so-called horse latitudes 
north of this belt, as well as in the equatorial zone of 
calms, the heat sometimes becomes quite distressing, and 
is acknowledged to be harmful. 

Thirdly, there is the stimulating effect of abundant 
sunlight and strong winds. North of the 45th parallel, 
it must be said, the excess of sunshine is not much in 
evidence, and the mantle of clouds may be unbroken 



HEALTH RESORTS 199 

for weeks at a time in autumn and winter; in warmer 
latitudes, save in the cloudy equatorial belt, the sun 
does shine for about three-fifths of the time. As to the 
breezes, we can understand that, they are very desirable 
when moderate; but since, in most regions, they develop 
into gales at frequent intervals, they are apt to involve 
considerable discomfort to the health-seeking landsman. 
Violent winds are an objection to many coast stations; 
it is easy to comprehend their still more trying roughness 
on shipboard. 

Fourthly, we may turn to consider the mental rest 
that comes with a sea voyage. This does exist on the 
longer and less traveled routes, and really forms the 
most incontestable advantage of such a trip; it is, 
unfortunately, almost altogether absent on such short 
and tourist-frequented lines as those to Europe and the 
West Indies; indeed, for the reason stated, these short 
voyages have been omitted from the list of our thera- 
peutic resources; life on a great liner has become exactly 
like that in a fashionable hotel, without the means of. 
avoiding tiresome neighbors by taking a walk or drive, 
a*s is possible on shore, when the sense of ennui "becomes 
oppressive. These objections apply almost equally to 
those longer tours, now extremely popular, to the Medi- 
terranean and the Spanish Main-, on which an almost 
continuous round of amusements and sight-seeing con- 
sumes the time and energies of the traveler; such 
voyages, also, can rarely be recommended to invalids, 
with any confidence. 

We have gone over the real advantages of ocean voy- 
ages, and noted the corresponding drawbacks, but there 
are other deficiencies that are without any sort of 



200 THE CLIMATIC TREATMENT OF CHILDREN 

compensation. Most important of all, those long routes, 
which alone give the desired rest, are without the services 
of a really first-class medical attendant ; it is still cus- 
tomary, on many lines, to engage a very young surgeon 
for a single voyage; he is apt to be a practitioner with 
few qualifications for the management of a chronic, 
especially a neurotic invalid. Secondly, these same 
lines, as well as some very popular ones, furnish their 
passengers with food that is often coarse and lacking 
variety, readily disposed of, perhaps, by the conventional 
type of robust Briton, but quite unassimilable by a per- 
son whose digestive powers have become impaired. The 
situation of a delicate child, not quite accustomed to 
the motion of the ship, confronted with such comestibles 
as boiled corned beef and roast pork, instead of its proper 
food, is not fraught with great promise of rapid restora- 
tion to health. * Thirdly, of course, comes seasickness, 
which I mention last because it is usually overcome in a 
few days; some persons, however, never acquire a good 
pair of sea legs, and the first patient that we send on a 
sea voyage, for his health, may be one of those unfortu- 
nates. The result to him and his physician is likely to ■ 
be not at all questionable. 

We have jotted down sufficient data to establish the 
doubtful value of sea voyages in the treatment of disease ; ' 
we may add that all the adverse circumstances are 
aggravated in the case of children, and some of the good 
ones impaired. The subject has been presented for the 
sake of completeness, and because of its former vogue in 
certain medical circles of high repute; it has evidently 
entered on a stage of declining popularity, and shall 
receive little attention in the later chapters of this 



HEALTH RESORTS 201 

treatise. The benefit - of an ocean voyage may be 
obtained quite as readily, with no risk and less discom- 
fort, at the ocean's edge. 

SEA BATHING 

While it is apart from the purposes of this manual to 
discuss hydriatric or balneological treatment, the special 
variety of sea bathing is so closely interwoven with cer- 
tain aspects of climatotherapy, that a few remarks on 
this subject are not easily avoidable. In sea baths we 
possess a particularly powerful stimulant; they form 
one of the more strenuous hydrotherapeutic procedures 
under some conditions; under others, again, they may 
be regarded as a rather mild measure. This difference 
is mainly due to variations in the sea temperature, partly 
to the quality of the surf and the coincident temperature 
of the air. It is clear that we must observe certain pre- 
cautions in administering sea baths to children, even 
more than in the case of adults, so that the following 
notes will not be superfluous. 

Strong surf, with violent breakers, is to be avoided 
totally, for, aside from the actual danger which exists at 
many places and has led to fatalities, the element of 
fear on the part of the child cannot safely be disregarded, 
and the physical shock of the pounding seas is almost 
always felt very unpleasantly, and leaves a good deal of 
prostration in its train, save in an unusually robust sub- 
ject. At places where the conditions are such as just 
mentioned, the period of low tide should be selected as 
the bathing time, for the breakers are then relatively 
small and feeble. This necessitates an almost daily 
shifting of the hour for the bath, often to inconvenient 



202 THE CLIMATIC TREATMENT OF CHILDREN 

portions of the day, so that one is often tempted to omit 
treatment for a week at a time. In stormy weather, an 
intermission, until the sea quiets down, is also invariably 
necessary. 

For fairly robust children, the temperature of the 
water should not be lower than 60 to 65 degrees, for the 
more delicate ones 70 is the limit. Unfortunately, relia- 
ble data as to the ocean temperature at the various 
resorts are fragmentary; I shall have to furnish many 
facts from personal observation. On our Atlantic coast, 
Massachusetts is near the northern limit for children, at 
least of tender years, the season lasting from early July 
to the end of August ; in New Jersey, the water is often 
sufficiently warm in the latter half of June, and baths 
may be continued well on into September. The season 
progressively lengthens as we go south, until, in southern 
Florida, the water is none too 'cold in midwinter. On 
the Pacific coast the water is rather cool everywhere, 
the difference between the summer and winter being 
insignificant, whereas it amounts to over thirty degrees 
off New Jersey. Santa Barbara represents about the 
northern limit in California for all but the very robust, 
and even here the average temperature of the water is 
only 65 degrees in summer, though it averages 60 in win- 
ter; at San Diego fairly hardy children can indulge in 
ocean baths the year round, by selecting favorable days. 
Turning to Europe, we find that the Mediterranean is 
sufficiently warm only from May to November, for its 
winter temperature (55 to 60 degrees) is rather low for 
young invalids, though some seaside sanatoria adminis- 
ter sea baths throughout the year, even in frosty weather. 
In midsummer the temperature of the Mediterranean 



HEALTH RESORTS 203 

Sea is quite uniformly 78 degrees, similar to that of our 
South Atlantic coast, and warm enough to permit quite 
a prolonged stay in the water. On the west coast of 
Europe conditions resemble those on our Pacific coast; 
north of the Bay of Biscay temperatures above 65 de- 
grees are rare, and only very short dips are permissible. 
On the German coasts we note a decided difference be- 
tween the North Sea and the land-locked Baltic, The 
former has strong tides and a fairly rough surf, and is, 
in fact, almost altogether unsuitable for our purposes; 
the latter is somewhat warmer in summer, and very 
much quieter, and the Germans give it a very decided 
preference. The Channel resembles the North Sea, save 
that it is warmer and less rough, but the tides are very 
strong. The temperature here is just warm enough for 
a very brief plunge, as it rarely rises much above 60 
degrees under the most favorable conditions. 

It will be seen that the above outline is somewhat 
sketchy. The trouble lies chiefly with the advocates of 
strenuous hardening, who cannot find the water cold 
enough; conservative investigators in this field have 
remained conspicuous by their absence. 

As to the duration of sea baths, I can lay down a fairly 
good plan from my own observations. Robust children 
may stay in only for a minute or two, when the water is 
at 60 degrees ; at 65 three to five minutes may be allowed, 
at 70 ten minutes or a little more; on those occa- 
sions, exceptional on our Middle Atlantic coast, when 75 
degrees are reached, even fifteen to twenty minutes may 
do no harm if the air is warm, and the weather sunny. 
For more delicate and younger children these allowances 
must, of course, be reduced, and the 60-degree baths cut 



204 THE CLIMATIC TREATMENT OF CHILDREN 

out altogether. The common- American custom of pro- 
longing sea baths until cyanosis is fully developed is 
highly reprehensible and harmful; the reaction test 
applies to sea baths as well as to those taken in a tub, 
and its development is the signal for leaving the water. 
If the reaction fails to set in at all, the bath has been too 
cold, and is not suited to the individual in question. 

To obtain the full benefit of a sea bath, it is almost 
essential that the air should be warmer than the water; 
a slightly lower temperature of the atmosphere may, 
however, be compensated by bright sunshine and the 
absence of strong winds. The best time for bathing is 
about an hour before the noonday meal; when this is 
prevented by tidal conditions, a shorter dip before 
breakfast, or a bath in the middle of the afternoon may 
be substituted ; preferably the former, unless the weather 
is very cool or the sun obscured. 

GENERAL REMARKS 

Erb 1 has very wisely said that we may send our 
patient to a good climate, but cannot control the weather 
after he arrives there. When he visited the Engadine 
in December he found no snow to speak of; the natives 
assured him that this was phenomenal. When I visited 
Rome in January 1894, Lfound a veritable New England 
snowstorm raging; the remarks of the natives corres- 
ponded precisely to those recorded by Erb. Atlantic 
City, the present eastern climatic panacea, had a Massa- 
chusetts winter in 1904-5, and a Virginian one in 1905-6. 
Los Angeles, the western Mecca of health .seekers, is 
deluged with rain in one winter, and desert-like in 

1 Sammlung klinischer Vortrage, 1900, No. 271. 



HEALTH RESORTS 205 

another; in St. Augustine there is a frequent alternation 
in the prevailing equipment between furs and fans. 
Similar variations obtain at nearly all other health 
resorts. 

It is evident that the best laid plans of climatotherapy 
may end in disappointment. The gauging of climate 
has reached mathematical accuracy, the prediction of 
the weather rarely succeeds beyond forty-eight hours. 
All that we can promise our patient is the probability of 
certain conditions, but we cannot assure him that he 
will find more than an approximation' to the object of 
his search. It is a doubtful procedure, therefore, to 
send an invalid to a climate that does not differ from 
that of his home quite fundamentally; unless careful 
climatic study precedes such advice, it were better not 
to give it at all, save where the mere change of scene is 
a desideratum. 

More failures, however, result from mistaken notions 
about the climate of regions unfamiliar to the counseling 
physician. The delusion as to the remarkable mildness 
of Lakewood and Atlantic City, so fondly cherished by 
New York physicians, and encouraged by . financially 
interested parties, is paralleled everywhere. I have 
referred to the "dry" cold of the Adirondacks, and the 
"dry" heat of Arizona, of which only the latter is a fact, 
but not any too comfortable on that account. It is well 
to remember that winter remains winter, save in the 
tropics, and that summer brings some hot days every- 
where, except in positively arctic climates. The patient 
should therefore be advised to provide clothing adapted 
to the season, not to certain reported conditions that 
may be exceptional. The physician, for his part, should 



206 



THE CLIMATIC TREATMENT OF CHILDREN 



study climate from the ample data now at hand, referring 
to statistics when necessary; treatment according to 
time-honored traditions or random information is to-day 
as inexcusable an error in climatotherapy as in every 
other branch of therapeutics. 



CHAPTER IV 

THE CLIMATIC MANAGEMENT OF THE NORMAL CHILD 

During intrauterine life no production of heat is 
required on the part of the foetus; the apparatus 
designed for that purpose is set in action only after birth, 
and functionates very imperfectly at the beginning, so 
that the infant's temperature sinks to 95 degrees and 
below during the first few hours. Throughout the earli- 
est weeks of infancy the abstraction of body warmth is 
borne very badly, any reduction by radiation into the 
relatively cool surrounding medium, especially if accel- 
erated by air currents, is compensated with difficulty, 
and a subnormal temperature, with its attendant risk 
of disease, is readily established. The indifferent tem- 
perature declines only very gradually from 99 degrees 
at birth to the figure normal at a later age, and exposure 
of any sort must be balanced quite accurately with suit- 
able clothing. Great and sudden changes of tempera- 
ture are extremely dangerous during this period, for it 
is impracticable always to combat them promptly with 
the application of additional external warmth and cover- 
ing. It is therefore advisable, save during very warm 
weather, to keep the .infant indoors during the first 
month, regardless of the season. 

After four or five weeks the question of the baby's 
first outing comes up, and must be decided according to 
circumstances, sunshine and warmth being the prime 

207 



208 THE CLIMATIC TREATMENT OF CHILDREN 

requisites. The time should be about noon, on a bright 
day, with little wind, and a temperature not below 65 
or 70 degrees. It is evident that in winter, or in a cold, 
gloomy, or windy climate, the first airing is likely to be 
postponed for weeks and even months; the parents as 
well as the medical attendant are the.n apt to become 
impatient. It is undeniable, however, that any material 
deviation from this rule, arbitrary as it seems, is a hazard- 
ous experiment; too often the infant's first illness is 
directly traceable to an ill-advised attempt of this kind, 
and it is better to err on the side of excessive caution. 
It is, of course, understood that a certain relaxation of 
the above -requirements is permissible in an infant that 
has attained the age of two, three or four months; the 
temperature in particular need not be nearly so high as 
just stated. 

Throughout infancy, the child should be kept at home 
in the early morning, and brought back within one or 
two hours of sunset; the advantage of breathing the 
purer air out of doors is more than neutralized by the 
dangers involved in exposure to the chilly dampness 
that prevails shortly after sunrise, and the increasing 
humidity and rapid fall of temperature in the late after- 
noon. In places subject to the sea breeze special pre- 
cautions must be taken during the latter portion of the 
day, the spring months calling for particular care in this 
regard, whereas the late summer and autumn are less 
dangerous: at the last-named season the early hour of 
sunset gives ample warning to the infant's attendant, 
and the temperature changes toward evening are less 
abrupt. 

After the second year the child may gradually be 



CLIMATIC MANAGEMENT OF NORMAL CHILD 209 

inured to the climatic conditions that it will have to 
encounter during its school life. This is the age favored 
by the advocates of what is known as hardening, the 
training process through which the child is expected to 
revolutionize, both rapidly and thoroughly, the relations 
of its complicated and delicate organism to all kinds of 
atmospheric changes. We shall presently have abun- 
dant opportunity to give separate and detailed consider- 
ation to the subject of hardening; at this point it will 
suffice to state that any habituation to new and untried 
conditions must be effected gradually, step by step, as 
it were ; slow and sure methods are absolutely essential 
to secure a normal power of resistance to adverse cli- 
matic influences. It is, quite naturally, true that 
absolutely perfect results or even uninterrupted progress 
represents an ideal that we can hardly hope to attain; 
unlucky experiments and untoward happenings are 
almost unavoidable ; still, in view of the very remark- 
able eccentricities of most of the climates miscalled 
temperate, the net results of a system of training, fol- 
lowed consistently in the suggested fashion, average 
fairly good. This is the more creditable when we con- 
sider that, in a highly civilized community, the individual 
is endowed by heredity with a somewhat pampered 
constitution. 

The method of training just sketched, sound in theory 
and tolerably good in its results, is rarely carried out 
consistently and intelligently. Whereas the rearing of 
plants and the lower animals is largely in the hands or 
under the guidance of trained experts, that of the child 
is regularly intrusted to unskilled mothers or, still 
worse, ignorant nursemaids. The life history of the 



210 THE, CLIMATIC TREATMENT OF CHILDREN 

average city child consists, for the most part, of a suc- 
cession of respiratory affections during the cooler months, 
and digestive troubles in summer, this seasonal distribu- 
tion obtaining, of course, only in a general way. The 
final consequence is likely to be a more or less delicate 
constitution by the time the school age is reached. It 
is quite safe to say that the majority of such children 
as are below par, without demonstrating any definite 
organic disease, owe their relative feebleness to the 
cause stated; in our climate, at any rate, there can' be 
no doubt that frequently recurring and alternating 
"digestive and respiratory diseases play the leading role, 
exceeding even that of the infectious diseases, in stocking 
our communities with a race of young weaklings. 

I fancy that very few of us will dispute the general 
proposition that the theory of climatic training has not 
progressed beyond the merest outline ; yet this con- 
fessedly rudimentary plan is rarely subjected to that 
thorough and consistent trial, which alone can aid us in 
filling in the present rude framework. As matters 
stand now, the children growing up among us have an 
undeniable and lamentable tendency to be physically 
subnormal; they are evidently imperfectly fitted to 
withstand the ordinary vicissitudes of their environment, 
among which meteorological changes form perhaps the 
greatest part. 

The statistics of infant and juvenile mortality would 
appear to show that an era of progress has set in, and 
that the situation is improving; the fallacies in this 
argument are only too easily demonstrated. Formerly, 
only the fittest survived, the others succumbed; modern 
medical science saves many of the latter from death, to 



CLIMATIC MANAGEMENT OF NORMAL CHILD 211 

drag out a more or less impaired and wretched existence ; 
thus, many competent observers claim to note a steadily 
increasing ratio of subnormal children in both the urban 
and rural populations. 

It is evident, from the above discussion, that the 
prime indication is prophylactic; the climatic manage- 
ment of the normal child thus fills a large and not 
unfruitful field of medical endeavor. At the commence- 
ment of this chapter the opportunities for climatic 
training, in the ordinary sense, were shown to be greatly 
restricted during infancy and early childhood; we are 
therefore thrown back on those artificial aids, which 
may be called the climatic auxiliaries, namely, clothing, 
heating and ventilation. Of these, the subject of cloth- 
ing demands discussion here only from certain points of 
view; it involves at least as many social as hygienic 
considerations, and is known to have originated pri- 
marily through motives of the former class, to which the 
regard for mere health has always been subordinated. 
The employment of clothing, furthermore, may be re- 
duced to a minimum by an adequate supply of artificial 
heat; we may, therefore, for the present, pass by that 
subject to take up the more important themes of warming 
and ventilation, touching on the merits and demerits of 
the various methods whereby they are . obtained and 
regulated. 

Artificial Heating and Ventilation. For a young infant 
the proper room temperature is from 72 to 74 degrees; 
as the child grows older, this may advantageously be 
reduced to about 68. The heat of the American summer 
renders the maintenance of the proper room temperature 



212 THE CLIMATIC TREATMENT OF CHILDREN 

impracticable, save during the cooler periods; when a 
hot wave prevails it is apt, especially in stone houses, 
to remain persistently above 80 degrees for a week at a 
time. It is a curious but inevitable result of our highly 
artificial life that our apartments enjoy a more even 
temperature in winter than in summer; it follows that 
the infant is exposed to greater thermal vicissitudes in its 
home during the latter season. Now, there is some 
natural hesitation about stripping off the greater portion 
of an infant's clothing during a warm spell, and there is 
apt to be remissness in adding to its wraps when the 
weather cools off. The result is that the infant is very 
often either over- or underdressed in the summer season, 
and it is, of course, exposed to risks in either event. We 
find in this circumstance an explanation of the frequency 
and persistency of the " summer cold," which -may 
attack children who rarely suffer from disease of the 
respiratory organs in winter. 

We have noted that, to the nude body of the healthy 
adult, the indifferent temperature of the air is about 80 
degrees; it is undoubtedly higher in the case of infants 
and young, children, but the exact figure is indetermi- 
nable. Experience shows, at any rate, that a tempera- 
ture above 85 degrees, unless the humidity is very low, 
is distressing to an infant as ordinarily clothed; the 
baby becomes bathed in perspiration, which rapidly sets 
up an acute dermatitis, its sleep becomes light and fitful, 
its digestive apparatus becomes readily deranged; and 
its respiratory organs grow exceedingly sensitive to very 
slight thermal changes, the last two forming important 
parts of the physical condition called enervation. 

It is impossible to lay down a hard and fast rule as to 



CLIMATIC MANAGEMENT OF NORMAL CHILD 213 

the proper season for inaugurating the supply of artificial 
heat. So much depends on the construction and situation 
of the individual dwelling, that the room thermometer 
is practically the only trustworthy guide. Country 
houses, even in the latitude of New York City, may 
occasionally require an open fire during an exceptionally 
cool spell in summer; in cities, where the houses adjoin 
one another, we may safely await the first hard frosts of 
October or early November, and discontinue heating 
when settled spring weather arrives in the course of 
April. 

It will, perhaps, not be out of order to devote some 
space to the merits and deficiencies of the various modes 
of heating in vogue, five systems being in more or less 
extensive use in this country. 

The iron coal-stove may be mentioned only to be 
condemned. Its use involves a very unequal diffusion 
of warmth through the apartment, and there is al- 
most always some contamination of the air with carbon 
monoxid; this reaches a dangerous amount whenever 
there is a tendency to back draught, as may occur with 
certain winds or structural defects in the chimney, or 
be due to simple mismanagement of the stove itself. 
The porcelain stove, heated with briquettes of coal 
waste, which is in extensive use in western Europe, is 
almost ludicrous in its inefficiency, even in the rather 
mild winters of Paris; in our northern states it would 
be all but worthless, and little effort has been made to 
popularize this very inadequate heating apparatus on 
our side of the Atlantic. 

The open fireplace, burning either wood, coal, or gas, 



214 THE CLIMATIC TREATMENT OF CHILDREN 

has much to recommend it, since it forms a perfect 
ventilating plant as well, when in operation; its chief 
defect is that most of the heat escapes up the flue, and 
the room itself is barely warmed at all; almost all the 
benefit we get from an open fire is by direct radiation. 
For this reason alone, this method is suitable only for 
mild climates and the moderately cold spells of spring 
and autumn; during our northern winter it has merely 
auxiliary value, and may even be omitted altogether 
where other more efficient heating plants are provided. 
Most of our private dwellings are warmed with the 
hot-air furnace, which is easily worked and maintains an 
even temperature, though it will invariably be found 
that the upper floors receive much more warmth than 
the lower stories. This system combines with its un- 
deniable good qualities two serious defects. In the first 
place, it is entirely too well adapted to supplying our 
home atmosphere with baked street dust of various kinds, 
mostly unpleasant to contemplate. , This dust, further- 
more, is lar from sterile when it enters our rooms, for 
dry heat, of the moderate intensity applied in the furnace, 
is a most unreliable disinfectant. We may, however, 
mitigate this evil very largely by filtration through 
cotton, which must naturally be changed at intervals. 
The second, almost equally grave, and hardly remediable 
defect of this method is its effect on the relative humid- 
ity in our rooms. Saturated air at zero contains 0.03 
ounce of aqueous vapor to the cubic yard, at 70 degrees 
it contains about 0.6 ounce; it follows that, in zero 
weather, the street air, taken into our houses and suit- 
ably warmed, has a saturation deficit of over half an 
ounce to the cubic yard, and a relative humidity of only 



CLIMATIC MANAGEMENT OF NORMAL CHILD 215 

five per cent. This does not, of course, actually occur 
to this degree, for such intensely dry air absorbs moisture 
from everything it touches, including the furniture of 
the rooms, and the human bodies inhabiting them. 
Under the best arrangement extant, however, the re- 
quirement to raise the proportion of moisture to 50 per 
cent., namely, the provision of about six gallons of 
water to half saturate the atmosphere of an ordinary 
dwelling, 1 with frequent renewal of this supply, is not 
fulfilled. It is true that a ridiculously small receptacle 
for water is attached to the furnace and supposed to be 
filled regularly ; some persons fasten tiny basins, holding 
about a pint, to the registers in their rooms; I doubt if 
the amount of water thus supplied amounts to a gallon 
a day under the customary management. It is there- 
fore not at all remarkable, that all who have investigated 
the relative humidity in our dwellings, report a desert- 
like dryness; Freudenthal, 2 for example, observed 15 per 
cent, in zero weather, and 30 per cent, on moderately 
cold days in his own house. Added to the above-men- 
tioned dust, such intense drought is certainly injurious 
to the respiratory mucous membranes; whether it favors 
the development of adenoid hypertrophies is still an 
open question, but I am inclined to agree with those 
who answer in the affirmative; the sudden increase in 
the number of rhinitis cases, when the furnaces are set 
going, is so striking as to make some sort of etiological 
relation highly probable. 

It is not easy to suggest an adequate remedy for this 
defect of the hot-air furnace; the air passes through far 

1 A house measuring 60x60x23 feet contains 3,067 cubic yards, 
\ ounce of water per yard equals six gallons. 

2 Journ. of the American Med. Association, November 9, 1895, 



216 THE CLIMATIC TREATMENT OF CHILDREN 

too rapidly to take up its proper quota of watery vapor 
in transit, even were it supplied. A larger furnace, with 
a slower air current, would entail increased expense, 
even if otherwise practicable. 

Heating with low-pressure steam has for many years 
been steadily gaining favor, and has monopolized the 
field in cool and cold climates, for all large buildings. 
The steam-heating plant has the great merit of sufficiency, 
which readily passes into excess on mild winter days, 
as well as in autumn and spring, when steam-heated 
apartments are invariably too warm. The attempt to 
correct this overheating by means of direct ventilation 
through open windows is very apt to create draughts 
that are the more dangerous because of the overheating. 
An additional drawback, of no little consequence, is the 
dissociation of the heating and ventilating plants; our 
engineers and architects have hitherto not succeeded in 
devising a good independent ventilating apparatus, and 
the air in steam-heated buildings is rarely as pure as one 
would desire. 

Heating with hot water does not differ essentially in 
principle from the preceding; it has found little favor in 
this country, and seems inadequate against the intense 
cold of our northern winters; in England, where severe 
winter weather is exceptional, it has come into use more 
generally. 

Turning to the subject of ventilation, we find that it 
resolves itself chiefly into the management of windows 
and doors. With the prevailing style of American win- 
dow, consisting of upper and lower sliding sashes, the 
admission of air from without can be regulated almost to 
a mathematical nicety, if the counter-openings of doors 



CLIMATIC MANAGEMENT OF NORMAL CHILD 217 

and flues and the direction and force of the wind be 
carefully considered. As a general rule, when the wind 
does not blow toward the window, opening at the top 
merely permits the egress of warm and respired air, the 
deficiency being made up through the door and furnace, 
also the fireplace, when not in use. Under almost any 
other conditions, air will enter through the window ; such 
is the case when the lower sash is open, or the fireplace 
is in use, or when a fairly strong breeze blows toward 
the room. It is a popular fallacy, readily exposed on 
any cold and windy night, that lowering the upper sash 
a few inches invariably contributes only to the exit of 
foul air; under the conditions just mentioned the air 
current is exactly in the opposite direction, and a cold 
draught descends from the top of the window, to the floor, 
very much in the manner of a waterfall. It is therefore 
extremely hazardous for a person, unaccustomed to this 
sort of exposure, to sleep directly under an open window, 
even if carefully covered. 

I mention the above practice and condemn it merely 
in passing ; it is one of the pet measures of the advocates 
of hardening, which may be indicated in adults suffering 
from chronic tuberculosis of the lungs, but need not, 
therefore, be prescribed for children in the offhand 
routine fashion nowadays so popular with many physi- 
cians who read much but reflect little. Similar errors 
will recur from time to time as we go on, and similar 
observations will have to be made repeatedly. 

The weather strip has been commented .on rather 
unfavorably in recent years, but it is hard to see just 
why; it seems to me that a window may as well shut 
tightly, if it is to be closed at all. 



218 



THE CLIMATIC TREATMENT OF CHILDREN 



The so-called French window, opening sideways, is 
inferior in many ways, the main objection being that the 
influx of air cannot be regulated with any exactness. 
The installation of a double set of these windows is 
altogether objectionable, except in regions experiencing 
intense cold ; the single window lets in some fresh air 
through slight defects in fitting, an advantage lost when 
double sashes are provided. 

Many persons, including some physicians, find it 
difficult to appreciate the difference between an open 
window and the open air, though the matter is simple 
enough. In the former case we admit a draught of 
usually cold air into a warm and almost stagnant atmos- 
phere, while the occupant of the room is dressed to-suit 
the latter only, and is therefore exposed to the danger 
of a chill; in the open the temperature is uniform, and 
the individual concerned is clothed accordingly, while the 
air currents are diffuse and intermingle freely. It is 
evident, therefore, that a veranda or open tent involves 
far less risk than a room with an open window, notwith- 
standing the apparently greater exposure ; it is easy to 
become habituated to the former, whereas, to a child 
at least, the latter is always hazardous in cold weather. 

From the above remarks, it is plain that the so-called 
" house-airing," nowadays so frequently recommended 
as a compromise, to the timid parents of children who 
would do better outside even in doubtful weather, is no 
compromise in any sense, but a measure replete with 
danger; the child is exposed to a cold draught at every 
inadvertent opening of the door. Throwing open the 
window wide does not decrease the clanger, but merely 
increases the discomfort to the occupant of the room. 



CLIMATIC MANAGEMENT OF NORMAL CHILD 219 

The chamber occupied by a young infant should not 
be ventilated directly, but through an adjoining room; 
an exception may be made to this rule, when the outside 
temperature exceeds 70 degrees, but, even then, care 
should be taken not to place the child right in the 
current of air, but to one side. The bedroom of an 
older child may be ventilated directly, if the following 
precautions be taken: the bed must not be set under 
the window, nor against any save a party wall, for the 
abstraction of warmth through an outer wall, on a cold 
night, is almost as dangerous as the draught through 
a window. It is also a good plan to fasten down the 
bed clothes with safety pins, for some children are in 
the habit of throwing off their blankets during the night, 
often with unpleasant consequences. In cool weather 
the windows of the playroom should be shut tightly, for 
such cold air as enters is sure to gravitate to the floor; 
it is a great deprivation for children to be prevented 
from creeping about on the rugs or carpet, so that this 
last precaution is quite indispensable. 

Housing. The demonstration of the bactericidal prop- 
erties of sunlight, by Downes and Blunt, 1 was hardly 
required, to convince us -of its supreme hygienic impor- 
tance; the Italian proverb: dove no va il sole, va il 
medico, expresses the common and correct opinion 
quite accurately. The exigencies of modern city archi- 
tecture absolutely ban the direct rays of the sun from 
some of our rooms, though in northern latitudes, where 
the sun describes considerably more than a half circle 
above the horizon during a great part of the year, its 
rays should enter every window at some time of the day 

^roc. Royal Soc. London, 1877, vol. 26. 



220 THE CLIMATIC TREATMENT OF CHILDREN 

during May, June and July. This can, of course, occur 
only where the houses are built widely detached. In the 
city of New York, the majority of lodgings in the flat and 
tenement houses have but one sunny room, which is 
usually not a bedroom; the advantages of a climate, 
that in wealth of sunshine fully equals " sunny Italy," 
are thus almost entirely thrown away, merely that land- 
lords may enjoy greater rents, and see real estate values 
rise. In most other American cities matters are some- 
what better, though too often only in the quarters 
inhabited by the well-to-do; in our small towns condi- 
tions in this respect are quite good, save for some bung- 
ling architecture that has planned unnecessary dark 
nooks and corners. 

The housing conditions in cities like New York are 
about as bad for children as can be imagined; to this 
we may add, during the colder months, a certain pro- 
portion of inclement weather which is less in evidence in 
equally crowded cities in milder regions, for instance, 
Naples. It is really remarkable that our city children 
are not more flabby and pale than we find them; that 
actual conditions are bad enough is seen in the report 
of the Chief Medical Officer of the New York Department 
of Health on the examination of school children. 1 

The only compensation for adverse conditions, such 
as these, is to take the child into the open air as much 
as possible, and to select the sunniest places, save during 
hot weather. It would seem absurd to add that this 
does not include exposing the baby's eyes to the direct 
rays of the sun, but a ten-minute walk through any of 
our parks will furnish abundant evidence that this hint 

1 New York Med. Journ., Aug. 12, 1905, p. 343. 



CLIMATIC MANAGEMENT OF NORMAL CHILD 221 

is not superfluous; the heedlessness of many mothers and 
nursemaids is almost beyond belief. Shelter from strong 
winds is also important on these outings, and it is hard 
to determine whether the cold and dry " mistral" type, 
or the strong damp sea breeze of April and May, is the 
more deleterious; my experience, however, inclines me 
to regard the former as the worse, since it brings severe 
cold with it, and is of generally greater violence. In 
very severe weather, exposure to sunlight indoors, when 
available, must often suffice as a substitute; careful 
adjustment of clothing is, however, of some importance, 
for the sunlit portion of the room is apt to feel very 
warm, on account of the radiant heat, even when the 
room temperature is at 70 degrees or below. 

I have not fo.und it necessary to draw aline on the 
thermometer below which an outing is barred. Holt 
keeps young children indoors when the outside tempera- 
ture is below 20 degrees; in my own experience I have 
seen infants above six months old exposed to far colder 
weather, the sunny and sheltered side of the street being 
chosen for the airing, and am convinced that no harm 
was done. It is, after all, a matter of habit; cold that 
is considered intense in New Orleans is deemed very 
moderate in New York, and passes for a harbinger of 
spring in Montreal. At the last-named place, drawing 
the line at 20 degrees would practically mean imprison- 
ment during most of the winter; in New Orleans it 
would mean exposure to all sorts of temperature changes 
in that most erratic winter climate. It is probably 
wisest not to draw any line, but to use one's judgment 
as wisely as possible. 

Clothing. We may now take up the subject of clothing; 



222 THE CLIMATIC TREATMENT OF CHILDREN 

I confess to doing so with considerable diffidence, and 
feel that the divagations of Herr Teufelsdrockh are 
nearly as useful as the latest manual of hygiene. Who 
will, for example, account for the fact that most adult 
males wear woolen underwear, whereas the so-called 
weaker sex deems cotton sufficient; yet both are liable 
to illness in about the same ratio, if indeed the male sex 
is not a little more susceptible? Man covers the chest 
and exposes the throat at all seasons; woman covers 
both or neither, regardless of the season. In my dis- 
pensary service the children suffering from bronchitis 
wear all the way from two to seven layers of clothing, 
plus or minus a red flannel chest-pad. I fear that the 
truest expression of our information on the subject is a 
mixture of empiricism, tradition, hearsay, prejudice^ 
fashion, eccentricities, dogmatism, nihilism, and a very 
moderate proportion of physical and physiological facts. 
It will take but a few lines to state what is practically 
useful and scientifically established. 

For deficiency in clothing there is one infallible test, 
particularly trustworthy in children, namely, coldness 
of the extremities in spite of a sufficiently high tempera- 
ture of the room; there is an equally accurate criterion 
for overdressing, namely, sensible perspiration, for the 
hyperidrosis common in neurotic adults is not often a 
source of confusion in early life. Many parents are 
strangely disregardful of the comfort of their children 
in this respect; young infants are apt to be overdressed, 
the coverings suitable to a surrounding temperature of 
70 degrees are kept on in the hottest summer weather, 
so that an acute dermatitis is added to the ordinary 
distress occasioned by the hot spell; after the age of 



CLIMATIC MANAGEMENT OF NORMAL CHILD 223 

three or four years too light clothing is commoner, and 
I have frequently seen children suffer intensely from the 
devotion of their parents to some such fad as the bare 
extremities fashion which is now particularly rife. 

As to the proper material for clothing children, there 
is at present a lively controversy between the advocates 
and adversaries of hardening. For young infants wool 
is generally recommended, on account of its being a 
relatively bad conductor of heat; on this subject some 
curious delusions and prejudices prevail. In the first 
place, wool ranks only a little lower than cotton as a 
heat conductor, and the low conductivity of most woolen 
goods is due to their loose texture and the air, one of the 
poorest conductors known, entangled in their meshes. 
Cotton goods of loose weave, such as Canton flannel, 
will be found to give nearly as great protection, and to 
have several advantages; for the rough edges of the 
wool fibers irritate the tender skin of the infant, as well 
as of many older children, and the thorough cleansing 
of woolen clothing is relatively difficult on account of 
this same roughness. Unless carefully handled, woolen 
fabrics tend to become felted in the laundry, thereby 
becoming hard and markedly increased in conductivity. 
It is probable that a mixture of wool and cotton is best 
suited to the purposes of underclothing. For outer gar- 
ments the above objections to wool do not, of course, 
obtain, and it is to be preferred in cool weather, at all 
events. Every observer will, however, notice, how the 
small boys always wear ostensibly woolen suits, and the 
little girls usually cotton fabrics, while the one sex 
seems to get on about as well as the other. 

Looseness of adjustment is an important desideratum 



224 THE CLIMATIC TREATMENT OF CHILDREN 

in the clothing of children, but has no special connection 
with the question of warmth or coolness, unless actual 
constriction takes place. The question of partial nudity 
will be taken up in our discussion of hardening, in a 
later paragraph. The matter of the color of clothing 
involves a number of refined points in physics that are 
not always clear and usually disregarded; as an instance 
I may mention that recent studies in radiology seem to 
demonstrate that red is the best protective color against 
the summer sun — the summer dress of most mammals 
is reddish brown — the mere suggestion of this would 
have been considered absurd a decade ago. The best 
color in winter seems to be black in the sun, and white 
in the shade, which suffices to demonstrate the imprac- 
ticability of carrying out any rule on this subject. 

The data just given amply illustrate the uncertainty 
of the relations of clothing to climatotherapy, and ac- 
count for the supremacy of fashion over hygiene in 
this field; the only point on which we can depend with 
some assurance is the quantitative factor, and we 
instinctively feel that we have done everything when 
we recommend light weights in summer and heavy ones 
in winter. 

"Catching Cold" The older authors attributed most 
acute, and many chronic diseases to " catching cold," 
that is, exposure to a sudden fall of temperature or a 
chilling of the body after previous warming. This belief 
began to lose ground under the influence of bacteriolog- 
ical research, and reached its minimum toward the turn 
of the century, when many of the most competent clini- 
cians regarded it with the greatest skepticism. Mean- 
while investigations have been conducted, to settle 



CLIMATIC MANAGEMENT OF NORMAL CHILD 225 

once for all whether the old creed is to be definitively 
abandoned, or merely revised to suit modern scientific 
standards. 

As far back as 1872 Rosenthal ' showed that animals 
warmed to a temperature of from 104 to 111 degrees 
assumed a subnormal temperature on ordinary exposure 
to the air. This experiment was supplemented by 
Affanassiew, 2 who cooled animals with the ether spray; 
so long as this cooling did not exceed a few degrees, no 
permanent effect was produced; when, however, the 
animals had been cooled off 20 degrees, many died in 
about 24 hours, exhibiting on autopsy cloudy swelling 
and granular degeneration of the hepatic and renal cells 
and the heart muscle, lesions which had often been 
referred to " colds." Control experiments were made 
by merely warming the animals to 104 degrees; no 
morbid changes resulted. Affanassiew' s experiments 
were varied somewhat by Lassar, 3 who employed the 
ordinary casualties of everyday life. He dipped rabbits, 
which had been kept at a temperature of 95 degrees, 
into ice water, then exposed them to the ordinary tem- 
perature of the room; within a day or two fever and 
albuminuria developed, of which the latter proved fatal 
in some cases, and led to chronic renal disease in others. 
There is some analogy to human disease in this process, 
but also an important difference; a cold in man is far 
more apt to entail a pulmonary than a renal affec- 
tion, and few investigators have succeeded in causing 
respiratory disease in rabbits by this method. One 
circumstance, of course, must not be disregarded, 

1 Berliner klin. Wochenschrift, 1872, No. 38. 

2 Centralblatt fur die'med. Wissenschaften, 1877. 

3 Virchow's Archiv, vol. 129. 



226 THE CLIMATIC TREATMENT OF CHILDREN 

namely, the wide gap between rodents and primates in 
the mammalian scale. 

Valuable information has been contributed by Nebel- 
thau and Zillessen. 1 Nebelthau found that the employ- 
ment of ice water is unnecessary; a mere thorough 
wetting of the animal's fur, and exposure to a strong 
draught of air as warm as 82 to 86 degrees, sufficed to 
produce hyperaemic lesions of the stomach and pulmon- 
ary lobules; some of the animals died within 6 to 12 
hours, but their death was not intimately connected 
with the stated lesions, which were not very extensive. 
Zillessen ascertained, with positiveness, that no true 
pneumonia was developed; he again found renal lesions 
with relative frequency. 

The net result is that in many animals, notably rabbits, 
exposure to the thermal shocks that are supposed to 
cause acute respiratory diseases in man produce no 
such effect, but provoke hyperemia and degeneration 
of the kidneys, which sometimes prove rapidly fatal, 
but not in a way similar to anything occurring in the 
human subject. The injuriousness of such exposure is 
clear, its modus operandi is not yet determined so accu- 
rately as to be immediately applicable to human pathol- 
ogy, and we must still . content ourselves largely with 
inferences. As to the individual variations, we know 
very well that, among human beings also, some are 
proof to thermal influences that would almost surely 
prostrate others. 

Even if preliminary overheating is not essential, there 
is overwhelming clinical evidence that it materially 
increases the liability to take cold. There is also no 

1 Inauguraldissertation, Marburg, 1899, . 



CLIMATIC MANAGEMENT OF NORMAL CHILD 227 

doubt, as already suggested in the first chapter, that 
the resistance of the organism to thermal shocks is 
seriously impaired by having been accustomed to a 
temperature even slightly above the indifferent point; 
this is the condition concisely but not quite accurately 
designated enervation. Then, of course, we may add 
other debilitating circumstances, such as general malnu- 
trition and chronic visceral disease. Finally, we must 
not lose sight of the relatively low resisting power of 
childhood, shared, incidentally, with old age; not only 
is this shown, as explained before, in the elevation of 
the indifferent temperature' during early life, but it 
appears quite as conspicuously in an increased sensitive- 
ness to changes, and a greater tendency to undergo 
enervation under a pampering regimen. 

The most active resistance to the whole theory of 
catching cold, as here outlined, has come from the 
bacteriologists; yet they have contributed some of the 
most valuable evidence in its favor. Pasteur * increased 
the susceptibility of fowls to anthrax by cooling them in 
a bath at 77 degrees, but his experiment is not perfectly 
applicable, because of variations easily introduced into 
the biology and culture of the anthrax bacillus; objec- 
tion might therefore plausibly be raised by the opponents 
of the "cold" hypothesis. Lode, 2 however, seems to 
have fully proved the increased susceptibility induced 
by draughts of cold air, especially after a wetting 
(increased radiation of body heat);, the animals thus 
exposed succumbed readily to infections to which unex- 
posed animals were far more resistant. We cannot 

1 Bulletin de l'academie de med., No. 12. 

2 Archiv fur Hygiene, 1897, vol. 28, 



228 THE CLIMATIC TREATMENT OF CHILDREN 

therefore doubt that exposure to cold, when the normal 
vasomotor compensation is interfered with, as after a 
wetting, or when it functionates inefficiently in conse- 
quence of enervation, renders the organism very much 
more susceptible to bacterial infection, with more exten- 
sive or intensive development of the contracted disease. 
We also see that the necessity of allowing for the presence 
of pathogenic micro-organisms does not affect our main 
proposition, for some of these microbes, for example the 
streptococcus or pneumococcus, are practically omni- 
present. 

Hardening. The connection between catching cold 
and the prevention thereof is presented in telling fashion 
by Kisskalt, 1 who lays down the following propositions: 
First, the tendency to disease is increased by arterial 
hyperemia, best illustrated by the condition popularly 
called overheating; secondly, the contraction of the 
blood vessels through the external application of cold 
(withdrawal of heat) causes an internal hyperemia, 
pathologically not to be distinguished from the conges- 
tion that forms the first stage of an inflammatory process, 
requiring, in fact, only the presence of bacteria or their 
products, to pass into that stage. Kisskalt' s third prop- 
osition refers to the circumstance that habituation to 
thermal shocks diminishes the contraction of the cutane- 
ous vessels and the secondary internal hyperemia; we 
therefore catch cold only when some part of the surface 
of the body has been chilled, and can reduce this reaction 
to surface chills by habituation. This process of train- 
ing the cutaneous vasomotor apparatus, so as not to 
react violently to every outward thermal influence, is 

1 Archiv fur Hygiene, vol. 39, No. 2, p. 142. 



CLIMATIC MANAGEMENT OF NORMAL CHILD 229 

commonly designated as hardening, and the next few 
pages will be devoted to a careful consideration of this 
mode of habituation as applied to children. 

It was a natural and logical trend of thought that led 
from the steadily increasing enervation due to our 
modern exceedingly h'igh standard of comfort, with the 
attendant risks just outlined, to the diametrically oppo- 
site system of physical training. Hardening is normal 
in the savage and barbarous races; the resisting power 
of the Red Indian, scantily clad as he is or rather was, 
to the vagaries of the American climate, had always 
evoked expressions of astonishment and admiration on 
the part of the '" palefaces," and the tendency arose 
in many quarters to bring up the white child in the 
most Indian-like manner compatible with the higher 
civilization. 

The promoters of this idea lost sight of a crucial fallacy, 
which has totally invalidated their argument. As a 
matter of fact, while the Indian does well enough in his 
primitive state in the lower stages of barbarism, he 
stands civilization very badly, becoming excessively 
subject to the white man's diseases so soon as he adopts 
his habits even in a modified degree, being, in particular, 
notably prone to tuberculosis. Countless generations of 
hardening have, in his case, been of no avail in counter- 
acting the enervation incidental to our civilization, and 
its after effects. Still, the experiment has been given a 
faithful trial, and, from early infancy onward, children 
have been exposed to wind and weather in the hope of 
avoiding the enfeeblement of the normal resistance that 
follows pampering and coddling. 

It is unnecessary here to enter minutely into the 



230 THE CLIMATIC TREATMENT OF CHILDREN 

history " and details of the hardening movement in 
pediatrics; failure of the milder methods gradually led 
to increasing strenuousness, until the most popular pro- 
cedures attained the degree of severe physical torture, 
such as only an intimidated and helpless child would 
tolerate. Frequently repeated cold baths and insuffi- 
cient clothing came into vogue ; running about, barefoot, 
in and out of doors, ranked among the milder and there- 
fore more amusing measures. It is only necessary to 
glance at the recommendations of Hochsinger, 1 who lays 
claim to conservatism, to see how even cool-headed 
practitioners have been carried away by this monstrous 
fad, for it is nothing more. 

For all this enthusiasm, to which the comfort and 
happiness of countless children have been sacrificed, we 
can record nothing but still more failures; the young 
victims continued to catch cold at least as often as be- 
fore, and in addition developed other weaknesses which 
were actually rarer before strenuous hardening became 
the fashion. Fortunately, the movement had to come 
to a halt at this point, because it was physically impossi- 
ble to push the theory of hardening any further. 

The truth of the matter seems to be that any harden- 
ing that is at all feasible under the conditions of our 
civilization is bound to be imperfect; furthermore, there 
is great risk of overstimulating and thereby exhausting 
the thermoregulatory centers if an excessively strenuous 
system be followed; we find a parallel to this in the 
"going stale", of overtrained athletes. There seems to 
be a limit to which the endeavor to inure the organism 
to thermic shocks can safely go, and beyond which it 

1 See bibliography. 



CLIMATIC MANAGEMENT OF NORMAL CHILD 231 

cannot be forced without a reasonable certainty of dis- 
organizing the whole apparatus. This danger line is 
reached far more. readily in children than in adults; in 
the case of young infants this has indeed usually been 
recognized, and only the most rabid advocates of harden- 
ing ventured to apply their methods to the first year of 
life. 

Hecker x was the first to call a halt to the votaries of 
strenuousness ; he found that, among his clientele, the 
rigorously hardened children were just twice as likely to 
catch colds as the totally unhardened, and that the 
moderately hardened children occupied an intermediate 
position. The hardened children had, moreover, a 
marked tendency to neuroses and anaemia, and nearly 
always gave the impression of being " delicate." Special 
stress had been laid on hardening as a preventive of 
adenoid hypertrophy in the naso-pliarynx and fauces; 
Hecker found this lesion in 40 per cent, of the hardened 
children, but in only 20 per cent, of the unhardened. 

Hecker's observations have obtained ample confirma- 
tion, and have, of course, been vehemently attacked by 
the radicals; fortunately, it is most easy for any prac- 
titioner to satisfy himself as to the leading fact, that the 
coddled children are not any more susceptible to respira- 
tory affections than the hardened ones, while those who 
are handled • with ordinary intelligence, rather than 
dogmatism in either direction, seem to thrive best of all. 
The final result, suggested at once by common sense, is 
as follows: Young infants should be treated with the 
utmost care to avoid anything like severe exposure; 
after the first year gentle attempts should be made in 
1 Miinchener med. Wochenschrift, 1902, No. 45. 



232 THE CLIMATIC TREATMENT OF CHILDREN 

the way of a more strenuous regimen, but children 
under six or seven years always demand complete pro- 
tection against Gold and wet. With the commencement 
of school life a little more latitude is necessary, and may 
be permitted; dry cold may be disregarded, whereas 
dampness and chilliness still call for due precautions. 
Full exposure is only to be thought of after puberty, and 
here, too, we must beware of routine, for, as a conse- 
quence of centuries of civilization, with its ample pro- 
vision of shelter and artificial heat, many individuals 
are affected with what may be called hereditary enerva- 
tion. Such persons are and remain sensitive to sudden 
temperature changes, and it is quite impossible to 
habituate them to conditions that are regarded with 
indifference by the wild Indian. On the whole, however, 
the power of resistance usually increases up to the 
thirtieth year, to decline again at the onset of senility; 
thus, a course of hardening which would be . absolutely 
harmful to a young child may very possibly be suited 
to an adult enervated by a hot climate, dissipation, or 
general hygienic neglect. 

Hecker has appended to his admirable critique certain 
recommendations which embody his idea of .a rational 
course of hardening. He seems, withal, to stand in 
some awe of the radicals, for I should say that even he 
advocates a regime that savors of excessive* strenuous- 
ness in a number of minor details, as will appear in the 
following review of the several points that he enumerates : 

In the first place, he advises us to begin by accustom- 
ing the child to the bedroom temperature, allowing it to 
run about barefooted or even nude before being tucked 
in. This suggestion sounds a little strange from an 



CLIMATIC MANAGEMENT OF NORMAL CHILD 233 

opponent of severe hardening, more especially from a 
resident of Germany, where the customary temperature 
of the bedroom is lower than with us, namely 60 to 64 
degrees. Even an adult cannot remain stripped at any 
such temperature without shivering violently after a 
few minutes, and most of his body is at a greater dis- 
tance from the still colder floor. The room temperature 
is usually taken at about five feet of elevation, but in 
winter, even when artificial heat is supplied near the 
floor, the lower strata of the room atmosphere are from 
four to six degrees colder than indicated at the usual 
level of the thermometer. It is evident that no child 
should be permitted to play on the floor of its apartment 
in a partially or wholly undressed state, except during 
the warmer months of the year. Hecker's first proposi- 
tion is only a shade less objectionable than the cold 
baths he so justly condemns. 

His second recommendation, to take the child out of 
doors after the age of six months, unless the weather is 
very cold or stormy, I have already indorsed; when, 
however, he advocates the removal of shoes and stock- 
ings in summer, even the so-called summer of Munich, 
which resembles the latter half of May in New. York, 
he seems to be conceding' too much. Aside from the 
possibility, in fact likelihood, of traumatism in this age 
of tacks and broken glass, it is, to begin with, unsuited 
to even a warmer climate, except indoors in the hottest 
weather, and is, furthermore, unpractical as a measure 
of training, since the prevailing standard of civilization 
requires its abandonment in later life. Unless fashion 
will permit adults to go about barefoot it is hard to see 
any real purpose in this mode of hardening. 



234 THE CLIMATIC TREATMENT OF CHILDREN 

Hecker's third recommendation, to avoid the use of 
furs, and to leave the throat bare, is quite proper for a 
climate such as that of Germany, and our middle and 
southern states; it must, of course, be abandoned in 
regions where temperatures below zero are frequent. A 
modicum of common sense will solve this question with- 
out difficulty. As to his suggestion to leave the legs 
and arms bare, objections will occur to us at once. This 
curious fashion has no special effect, except to facilitate 
the work of biting insects, and subject the exposed 
extremities to an infinity of annoying cuts and scratches, 
with more or less risk of septic infection, besides leading 
to painful sunburn under appropriate conditions. Thin 
coverings are almost as cool as nudity and afford pro- 
tection against the injuries mentioned. I might add 
that, even in our middle states, the summer is not 
adapted to exposure of this kind save during excep- 
tionally hot periods, and I have seen small children 
undergo severe suffering on cool summer evenings, 
simply because their parents had semi-barbaric tastes in 
dress, at least as far as their offspring were concerned. 

As to Hecker's recommendations on the subject of 
hydrotherapy, I may say 'that I quite agree with him 
when he prefers cool sponging to immersion, and uses 
the sensation of the child as a guide; if it enjoys the 
process there can be no objection, and this will usually 
be the case' if the room be carefully warmed and the 
child permitted to stand in a few inches of warm water. 
Strenuous objection on the part of the child makes the 
advisability of any but tepid baths (86 to 90 degrees) 
doubtful, and I would not recommend sponging with 
water colder than 68 degrees, even for the most robust ; 



CLIMATIC MANAGEMENT OF NORMAL CHILD 235 

the reaction should be watched closely in every case, and 
its absence noted as a positive contraindication. 

Strenuous hydrotherapy has been the main reliance 
of the advocates of hardening and the most prolific 
source of mischief; the more radical advocates of this 
discipline abstracted the necessary body heat from their 
young victims by plunging them into tubs of cold water 
two or more times a- day, and then wondered why they 
caught cold even more frequently than admittedly pam- 
pered children. 

Hecker's final advice : to harden gradually, to indivi- 
dualize, to wait until the age of two or three years before 
beginning, and to take special care with anaemic and 
neurotic children, cannot be followed too conscientiously. 
I would add that we might, in general, harden children 
even a trifle less than permitted by Hecker; he him- 
self noted that moderately hardened children showed a 
higher morbidity than those not hardened at all. I do 
not, of course, mean thereby that children are to be 
pampered and coddled, and guarded from every breath 
of cool and fresh air as if it bore contagion, but am fully 
satisfied that, in this field, too little is better than too 
much; a manner of living that lends robustness after 
puberty is not for that reason suitable to an earlier age ; 
the young organism is far more delicate, and has in 
particular a smaller caloric reserve. This last is shown 
by the great tendency in childhood to cold hands, feet 
and. ears, and frostbites' of every degree, including the 
annually recurring winter eczema of the face and hands; 
it is high time that the fact were universally appreciated, 
that not only infants, but older children in a gradually 
diminishing degree, are intolerant of low temperatures. 



236 THE CLIMATIC TREATMENT OF CHILDREN* 

Summer Resorts. From various remarks in this as 
well as the introductory chapter, the reader may have 
gained the impression, which is strictly correct, that 
occasional moderately hot weather, say 85 degrees of 
heat with less than 70 per cent, of humidity, otherwise 
a sensible temperature under 77 degrees, is not in itself 
injurious to the very young, though it may be trying to 
their elders, who are obliged to dress according to con- 
vention, and work for a livelihood besides. It was 
shown at the outset that, with proper general hygiene 
as to pure air and clean food, there is no occasion for an 
especially high infant morbidity and mortality during 
the ordinary summer weather of our northern cities, 
while in the country districts the summer should be 
conspicuously the most healthful season. It has, in 
addition, been noted that infants do not do much worse 
in our southern states, where the cities are relatively 
small, with detached houses and plenty of shade out of 
doors, provided that the milk supply be .of good quality. 
The matter of milk inspection, in its many aspects, does 
not concern us here; we have therefore to consider 
mainly the question of fresh and pure air, which by 
itself will guide us readily and sufficiently in the selec- 
tion of a summer, resort for young children and infants. 

Nearly all our country places, except the very hot 
ones, are beneficial to infants, who thrive luxuriantly in 
localities where their elders pant with the heat and 
humidity. There are, however, some factors that may 
aid us in the choice between seaside and inland resorts, 
the question that perennially is brought to the attention 
of the family practitioner, and that he must solve in an 
intelligent manner. As we have already . considered a 



CLIMATIC MANAGEMENT OF NORMAL CHILD 237 

large mass of climatological data concerning individual 
localities and districts, it remains for us only to generalize 
as to climate, and specialize as to the patient, and we 
surely ought to be in a position to select wisely and witb 
good reasons. 

• Seashore Resorts. During the child's first summer, 
the seashore meets the desirable indication of an even 
temperature. A good sea breeze, bringing the pure 
ocean air, tempers the heat of the day, and the fall of 
the thermometer at night is relatively very small. A 
rather high average temperature, as we have" said, offers 
no objection, and the somewhat sultry summer of Long 
Island and New Jersey seems to be the. very thing for 
young infants, superior to the very cool, sometimes 
almost raw, summer climate of eastern Maine and Nova 
Scotia. At the same time an excess of windy weather 
is to be avoided ; such places as Block Island are perhaps 
a little too much exposed; the infant must be kept in- 
doors rather frequently, even on some tolerably bright 
days; this seems like a waste of good opportunities. 
The sea fog is, of course, to be shunned; it increases in 
frequency toward sunset, and as we go northeastward, 
and furnishes another reason for preferring the Middle 
Atlantic Coast to that of northern New Englaifd; for 
this cause also, the entire Pacific Coast north of Santa 
Barbara is objectionable, not to speak of the very low 
temperature that prevails everywhere. Residents of 
the North Pacific States and the greater part of California 
cannot take their young infants to the seashore with 
advantage, but must select sheltered semi-inland locali- 
ties, where the violent ocean winds and fog rarely pene- 
trate. Among European coast resorts, those of France 



238 THE CLIMATIC TREATMENT OF CHILDREN 

are unquestionably the best; the English and German 
seaside stations are rather chilly, those farther south 
too warm and usually malarious. 

During its second summer the infant no longer 
demands a high temperature so imperatively, and the 
cooler seashore localities may be chosen with as good 
results as those of the Middle States. In Europe the 
south coast of England and the Baltic coast of Germany 
are highly salubrious for older infants, while the shores 
of the North Sea, being more subject to damp winds and 
fogs, are better adapted to children past the age of 
infancy. The last remark also applies to the Middle 
and North Pacific Coast in our country, some parts of 
which are, as a matter of fact, too rough for all save the 
hardiest adults. 

Inland Resorts. The inland resorts best suited to very 
young infants are usually felt to be a little too warm 
by older persons; examples of these are the river valleys 
from the Merrimac to the Susquehanna, which are 
quite free from really cool nights during July and 
August, and experience a large number of rather hot 
days. In the second and third summer we may, there- 
fore, with advantage, select cooler situations, provided 
that certain precautions are taken in the avoidance of 
isolated peaks, which are apt to be relatively windy, and 
are often shrouded in clouds when the weather round 
about is fair. Deep valleys and especially hollows are 
very objectionable, as they are subject to dampness, 
sultry days with a sudden fall of temperature at night, 
heavy dews and early frosts. While under the head of 
ordinary inland resorts we include elevations up to three 
thousand feet, we must exclude a number of places 



CLIMATIC MANAGEMENT OF NORMAL CHILD 239 

below this level from the treatment of very young 
children. Among these moderately elevated localities, 
where the average temperature in summer is below 
62-64 degrees, and the nights are sometimes frosty in 
late August, we . may include the highest villages and 
hotels of our northeastern hills, and still more the moun- 
tain regions of northern and central Europe, such as the 
Scottish Highlands, and the upper levels of the Harz 
and Black Forest. These regions are too cool for chil- 
dren a year or two old, who may be deprived of many an 
outing on days that are raw and windy, but quite dry; 
every dry day on which a .child must be kept indoors 
is a day lost. With proper exposure, preferably on the 
south side of a gentle slope, the above-mentioned mean 
temperature is a pretty safe guide, but naturally summers 
differ somewhat, and a resort that is fairly mild in a sum- 
mer like that of 1901 may be very chilly in a season like 
that of 1903, the difference for July and August having 
been about five degrees in the northeastern states, and 
considerably more in the West. 

After the second year, when a mild degree of harden- 
ing may be advantageous, we may avail ourselves of the 
cooler inland stations, but a certain amount of indivi- 
dualization is in order. Robust children do well at 
these resorts, but delicate specimens require more care- 
ful handling, and it is advisable to keep them in a rather 
warm summer climate a year or two longer. It is true 
that climatic hardening, administered during the warm 
season, is a very mild form of physical training; this 
fact, however, must not invite recklessness, and it will 
generally be found that the child, that has undergone 
the least strenuous exposure to the elements, returns 



240 THE CLIMATIC TREATMENT OF CHILDREN 

home in autumn in the best condition. Still, I would 
not be understood as favoring a regime of coddling with 
advancing years, and consider a mild form of climatic 
discipline one of our best means of educating the young 
organism to withstand the physical strain that will be- 
fall it in later life. A few years later, say after the age 
of five, the moderate amount of exposure involved in a 
stay in a really cool summer resort is almost imperative ; 
older children undoubtedly profit more by a few months' 
residence at> the cooler hill resorts than by being sent to 
warmer localities, especially at the seaside. Whether 
the cooler maritime stations, such as those of eastern 
Maine, are or are not as beneficial as the White 
Mountains or Adirondacks, is hard to determine, and 
individual idiosyncrasy undoubtedly plays- a part; my . 
experience, however, convinces me that the majority of 
children profit more by inland climates, for there is an 
excess- of dampness and fog at the colder seashore sta- 
tions; during warm spells there may be a few sultry 
nights even well to the northward along the coast, 
whereas uncomfortable nights, when blankets are a 
burden, are practically unknown at even moderate 
elevations in our northeastern mountains. 

Elevations. We have seen that an elevation above 
3,000 feet is not contraindicated per se in infancy and 
childhood, but the temperature conditions at high levels 
are not often suited to young infants, so that these 
resorts are better reserved for the third summer and 
thereafter. Even then the European high Alpine re- 
sorts are rather too cool, the temperature averaging 
below 60 degrees even in July, and there is often a 
large number of chilly and rainy days. These disad- 



CLIMATIC MANAGEMENT OF NORMAL CHILD 241 

vantages do not obtain in the greater part of the Rocky 
Mountain region; children tolerate the rather warm, 
but very dry and sunny days particularly well, and find 
the cool nights exceedingly refreshing; the necessary 
hypertrophy of the blood, shown in the increase of 
corpuscles and haemoglobin, is effected with relatively 
great ease in the youthful organism, being completed 
within three weeks without the manifestation of any 
noteworthy strain on the system. 

We must not fail to note, however, that the above 
remarks apply strictly to normal children; in a number 
of the less conspicuous chronic disturbances, the high 
mountain resorts are far from beneficial; the higher 
Alps, also, are adapted only to older children, who can 
be out of doors during the frequent spells of* rather 
autumnally cool weather. The nights in the valleys of 
the upper Alps are very apt to be damp, with heavy dews, 
and frost often attains a measurable thickness in the 
middle of summer, as I can testify from personal obser- 
vation. This sort of outing involves a fair measure of 
hardening, and cannot be recommended where there is 
any suspicion of a delicate constitution, or where the 
general nutrition is below par; it will be found that 
children thus afflicted experience considerable physical 
discomfort, lose sleep and become restless, so that 
latent neuroses are very apt to become manifest dur- 
ing or shortly after a summer spent under the stated 
conditions. 

Winter Resorts. In the selection of a winter resort for 
children it is well to set out with the understanding that 
no attempts at hardening should be made at this season. 
Even in climates that border on the tropics, the winter 



242 THE CLIMATIC TREATMENT OF CHILDREN 

months are characterized by marked and relatively 
sudden temperature changes, frequent frosts and occa-. 
sional snow, save where the mean temperature is almost 
summer-like. It seems hardly worth while to transfer 
a child to a climate that differs from that of its native 
surroundings only in a moderate degree; transportation 
from Boston to Washington, for instance, affords merely 
a rise of some half-dozen degrees, without any note- 
worthy change of the climatic type. 

One point, however, in which temperature does not 
play a part, is well worth considering. For example, 
we see that the winter months in 1901 furnished 56 
cloudy days at Buffalo, but not a single clear one, the 
other 34 being partly cloudy; whereas the same period 
at Atlantic City embraced 32 clear and only 22 cloudy 
days; the days with rain or snow numbered 79 at the 
former place, only 26 at the latter. A change from 
Buffalo to Atlantic City cannot but be beneficial, and 
the difference in temperature, seven or eight degrees, 
becomes altogether subordinate to the gain of 53 dry 
days, and a difference in cloudiness of thirty per cent. 
It is a fact that a number of points in the Lake Region 
afford young children hardly any good weather for an 
airing during the winter, and the extreme northwest 
coast is not much better in this regard, and in some 
respects worse, for the endurable light snows of the 
Lakes are there represented by drenching rains. Some 
of the points of northeastern Canada also suffer from 
bleakness, and the interior from New England to Indiana 
ranks only moderately high as to the number of fine and 
bracing winter days. With older children, therefore, 
say from two to six years of age, who are not suffering 



CLIMATIC MANAGEMENT OF NORMAL CHILD 243 

from any distinct morbid condition, but still seem to 
require more fresh air and outdoor exercise than they 
can get at home, the moderately cold resorts of the 
Atlantic coast, from Long Island to Virginia, may be 
employed with distinct benefit. 

Apart from the consideration just noted, we need 
pay attention only to such winter climates as have a 
decidedly spring-like temperature and plenty of sunny 
days ; we shall see that readily accessible places fulfilling 
this requirement are not very numerous, but may begin 
with the best, and then consider those that are only 
tolerably good, but nearer at hand. 

Almost the only perfect winter climate for young 
children and infants is that of southwestern California; 
as stated before, it resembles the New York October, 
but is even a little brighter, with just enough rain to lay 
the dust, a few rather warm afternoons, and as many 
light frosts. At San Diego and Los Angeles the winter 
usually comprises about 45 clear and only 15 cloudy 
days; rain falls on 20, but generally for a few hours only. 
We see that even tender infants need be kept indoors 
only exceptionally, older children only when rain is 
falling. » 

The warmer stations of Arizona, even aside from the 
inferior accommodations, are hardly so good; the ex- 
tremes of temperature are greater and there is an ex- 
cess of dust. On the other hand, there are very few 
days indeed on which children of any age must be kept 
in the house, and older children are almost certain to 
derive benefit from a brief stay in this section, especially 
when a really dry climate is indicated for any reason. 

Among foreign resorts the south coast of Spain, 



244 THE CLIMATIC TREATMENT OF CHILDREN 

Sicily and Algiers are not very inferior to southwestern 
California, but the accommodations and surroundings 
are not quite so good. For a very dry winter climate, 
middle and upper Egypt are perhaps rather better than 
Arizona. 

It is unfortunate that all these resorts of the first rank 
are removed from most of our great centers of population 
by a distance of from 2,500 to 6,000 miles, thereby 
involving a fatiguing trip and a high -cost of transporta- 
tion. We are therefore obliged to consider some places 
that offer a more or less imperfect winter climate,- and 
may begin with our very accessible southeastern states. 

The merits and demerits of Florida have already been 
fully discussed; we have noted that removal to the very 
warm, though changeable, winter climate of southern 
Florida requires extreme precautions with regard to a 
gradual return northward, which in the case of infants 
and young children should in no case take place before 
April, an intermediate station being selected for the 
early spring. From Charleston to northern Florida we 
have a winter climate too much like the northern April 
to be recommendable, unless a certain amount of hard- 
ening is an object, as is the case only in older children 
who are fairly robust. For a visit to our entire South- 
east, it is necessary to take along summer clothing, as 
well as quite heavy winter wear, and frequent changes 
from the one to the other are required in the more 
erratic seasons, as March and June weather alternate. 
It is thus seen that the climate of this region has but a 
limited applicability to childhood, and is defective in 
many respects. 

As to the Upper South, the general indications are 



CLIMATIC MANAGEMENT OF NORMAL CHILD 245 

similar to those of the Middle Atlantic Coast, but the 
winter in the former region is hardly so sunny, and 
more subject to excessive temperature changes, therefore 
affording no advantages over the latter. The sheltered 
localities in the southern Alleghanies, however are of 
some value, and we may say a few good words for the 
pine belt of the Carolinas. This entire section, like the 
Middle Atlantic Coast, is suitable only for older children, 
who either are quite robust, or only require toning up; 
and we may generally regard these resorts as a sort of 
makeshift, balancing their accessibility against their 
unquestionably second-rate merits. 

The last remarks apply equally to the Atlantic Coast 
of Europe, which is not very warm, though quite equable, 
and altogether too cloudy and stormy. ' Good results 
are said to be achieved so far north as the North Sea 
resorts of Germany ; they have indeed the mildest winter 
of that country, the temperature being similar to that 
of Cape May, but far less changeable. It is evident, 
however, that in these cases convenience of access has 
been deemed a compensating feature. The stations on 
the southern slope of the Alps belong to the same 
category, there is still a great deal of rather cold weather 
and some snow, atoned for, it is true, by ample sunshine 
and the rarity of sudden changes. 

Certainly the best resort among those of the second 
class is the Riviera, especially from Nice to Genoa. The 
temperature is not particularly high, but so even that 
neither summer clothing nor the heaviest wraps are 
likely to be called for. This climate involves the mildest 
possible degree of hardening without any enervation, 
and is too cool only for the extremely young and delicate, 



246 THE CLIMATIC TREATMENT OF CHILDREN 

who have to be handled with care in the best winter 
climates. Far inferior to this favored strip of country 
are the popular resorts of the Italian peninsula, such as 
Naples and its surroundings, Rome, which ranks still 
lower, and Florence and similar places, which are hardly 
worth considering at all. Stations subject to the mistral 
(or bora) are to be avoided entirely; they are trying to 
the most robust adults, and invariably harmful to chil- 
dren, who might as well remain at home to endure the 
northwest gales and equally bright sunshine of the New 
York and Boston winter, and have their home comforts 
when obliged to remain indoors. 

The colder winter resorts, such as. the Rocky Moun- 
tains and the hill country of central Europe, still more 
such subarctic winters as prevail in the Adirondacks, 
White Mountains, Upper Mississippi Valley, and Canada, 
are not suited to children at all. The dry, sunny, and 
only moderately cold winter of Colorado is perhaps the 
least objectionable of these, and may benefit older chil- 
dren, near the age of puberty, who are already endowed 
with some robustness; the other resorts mentioned are, 
however, not suited to our purposes in any save excep- 
tional cases; experience drawn from the observation of 
adults must not be allowed to guide us in the treat- 
ment of the young, for the reasons previously given and 
reiterated. 

Spring Resorts. The principles guiding us in the 
selection of winter resorts apply also to early spring; 
the uncertainties of the weather in March, northward 
also in April, are, as before noted, even more dangerous 
and trying than the more or less uniform, if variable, 
cold of winter. Such subtropical regions as southern 







r/. 



The Advance op Spring 
(Mean Temp. 54°) 



CLIMATIC MANAGEMENT OF NORMAL CHILD 247 

Florida and upper Egypt become too warm by the end 
of March, but most of our American winter stations, as 
well as those on the Mediterranean, are really at their 
best in early spring; semi-southern localities, such as 
Asheville and the Italian Lakes, are ideal April resorts, 
whereas such exposed marine situations as Atlantic City 
suffer somewhat from cool and damp sea breezes, though 
they have a high percentage of sunny days. Children 
who have spent the winter in the extreme South are best 
kept at an intermediate station during March and early 
April, for the benefit of California or Florida is sure to 
be partly lost by a too early return to our more northerly 
cities, even those so far south as Washington and St. 
Louis; New York City sometimes does not obtain real 
spring weather until late in April, and the Lake Region 
and New England until well on in May. 

In the accompanying map the average date of the 
arrival of settled warm weather is indicated, the mean 
temperature of 54 degrees being taken as the standard. 
Note the retardation of spring on the northeastern coasts, 
along the Lakes and in the Alleghanies. The extreme 
variation from the dates given is about two weeks, but 
in general it is remarkable how closely they apply, year 
after year, especially in the North; in Chicago, for ex- 
ample, this average temperature can be counted on, with 
almost absolute certainty, to be attained in the first half 
of May; in Philadelphia, in the latter half of April. 

It is not easy to strike a balance between the respective 
merits and defects of seaside and inland resorts in spring. 
As a rule, the marine localities have a larger proportion 
of clear weather, but suffer from strong and damp sea 
breezes, with fogs and low temperatures, in the late 



ZZSoj 



'My K 



•Se-^ 



111. 



iw<l 



O l 



i*y- 




The Advance op Spring 
(Mean Temp. 54°) 



_J 



248 THE CLIMATIC TREATMENT OF CHILDREN 

afternoon, sometimes for a week running; in the mean- 
time, the inland stations have more rain, a daily range 
of temperature that is sometimes enormous, very warm 
days alternating with frosty nights, and a very much 
higher average. Stations that are fairly near the ocean 
front, but not fully exposed to its influence, are perhaps 
the best of all, since they combine a fairly even and 
high temperature with relative dryness; among such 
resorts Los Angeles, Oakland, CaL, Old Point Comfort, 
and Lakewood may be recommended in this country, 
and such places as Pau in France and Florence and Pisa, 
in Italy. The ocean effect does not disappear entirely, 
as we leave the coast, until we come to a mountain range; 
it may therefore extend, gradually diminishing, fifty 
miles or more inland, especially on west coasts, as in 
California and France. The east coast sea breezes are 
less regular and limited to the coastal zone; the contrast 
between them and the warm land winds is striking, and 
the change from one to the other almost instantane- 
ous, attended with the most startling fluctuations of 
temperature.* 

What with the climatic tables and the above remarks, 
including the comments on winter resorts, the reader has 
been supplied with sufficient data to select a spring 
refuge judiciously. We need not therefore dwell longer 
on this subject, but may pass on at once to a brief 
consideration of the 

Autumn Resorts. There is little occasion here for 
prolonged discussion. The autumn climate, over most 
of the United States, is all that could be desired, and 
the invalid will rarely be in position to derive any par- 
ticular advantage from a change. Some variations, 



CLIMATIC MANAGEMENT OF NORMAL CHILD 249 

however, do exist, that are worth noting; they are a 
consequence of the vast differences in latitude. For 
example, to the south of Boston and Chicago a portion, 
at least, of September must be counted as summer, and 
treated accordingly; north of that line the latter half 
or even the whole of November becomes quite wintry, 
though the changeableness that characterizes midwinter 
does not yet appear to its full and objectionable extent. 
Autumn is almost everywhere the steadiest season of the 
year, especially so on the sea and lake coasts, which are 
therefore pre-eminently desirable as fall stations, north- 
ward in early autumn, semi-southern in November. At 
such places as Atlantic City and the Virginia coast the 
cold season steals on almost imperceptibly through a 
succession of bright days, and to a similar degree, but 
a little more irregularly, this is true on our inland plains. 
In the Lake Region and the northeastern mountains, 
however, the latter part of autumn is characterized by 
increasing cloudiness and a great deal of rain and snow; 
the same is true of practically all of Europe. Our Pacific 
Coast varies widely in this respect ; in Oregon, still more 
in Washington, disagreeable weather sets in in October; 
whereas in southern California summer conditions still 
prevail, and November is the first month of the so-called 
rainy season, with a proportion of sunshine that still 
amounts to 60 per cent. 

The above outline will suffice for the rare occasions 
on which an approximately normal child will require a 
change of climate in the fall. 



CHAPTER V 

CONSTITUTIONAL DISEASES 

In view of the fact that climatotherapy of necessity 
belongs, in the main, to the field of general, as opposed 
to special therapeutics, it is to be expected that its chief 
sphere of usefulness will lie in its application to consti- 
tutional or systemic, affections. This is so far the case 
that the general condition of the patient is usually our 
best guide in the climatic management of localized dis- 
eases as well; these will, however, be referred to in a 
later chapter, and we shall, for the present, confine, our 
discussion to such disorders as are more or less general- 
ized. In this connection we are emphatically reminded 
of the general therapeutic principle, that in all save the 
strictly specific methods, still relatively few in number, 
we treat the patient rather than the disease; we regard 
the sufferer chiefly from the standpoint of the physiolog- 
ical norm, and as deviating therefrom according to the 
nature, extent, and localization of the morbid process 
confronting us. 

Though climatic treatment is, from its very nature, in- 
evitably applied to the entire organism, it may neverthe- 
less be directed toward a definite symptom or symptom 
group, so that different diseases may call for man- 
agement along different lines. Truly specific climatic 
action is, however, practically unattainable; if recent 
studies have accomplished nothing further than to 

250 



CONSTITUTIONAL DISEASES 251 

disillusion the believers in climate as a true specific, the 
workers in this field will have obtained ample reward, 
in having finally set this branch of therapeutics on a 
sound scientific basis. 

In many respects, the preceding chapter forms the 
best introduction to the present; it not only supplies a 
general guide to climatic prophylaxis, but also gives a 
broad outline of the principles that should govern us in 
the treatment of disease. We have already referred 
repeatedly to that common source of error, now beginning 
to undergo correction, which fails to make allowance for 
the vast difference between children and adults, in draw- 
ing conclusions from reports dealing essentially with the 
latter. The last decade is witnessing a decided change 
for the better in this respect. Increased attention is 
being paid to the climatic treatment of children, en- 
tirely apart from that of adult subjects; the chief regret- 
table feature that still remains being the very one-sided 
geographical distribution of this modern view. Of 
the really valuable new material, the English-speaking 
nations, and notably Americans, have contributed little 
of any moment. The economist and sociologist may 
applaud or deplore the standstill of the population of 
France, but the therapist is unquestionably deeply 
indebted to it for the high development in that country 
of many departments of pediatrics, our special field hav- 
ing been assiduously and profitably developed by the 
minute and extensive studies of the French physicians. 
It is but fair, however, to record the valuable researches 
emanating from Germany, Belgium, Switzerland, and 
even Scandinavia, where the question of child conser- 
vation is less acute. British work has been rather 



252 THE CLIMATIC TREATMENT OF CHILDREN 

one-sided, the separation of the child from the adult hav- 
ing been effected but imperfectly; such countries as Italy 
and Russia, which suffer severely from chronic disease 
and disability among infants and children, have hitherto 
given little attention to our subject, although signs of 
an awakening are visible. It is to be regretted that 
this country has done the least of all the more enlightened 
nations; a number of well tried and elsewhere successful 
methods have been totally neglected or are only, now 
being considered; the reader will not fail to note the 
paucity of references to American authors on the pages 
that follow. It is neither necessary nor desirable to 
dilate on the causes of our remissness, they will occur to 
every one who is at all familiar with American public 
life; its effects are only too readily visible, especially in 
our large cities, where comments on the physical decline 
of the rising generation are growing ever louder and 
more insistent. It may be- true that our proletariat does 
not manifest degeneration to the extreme extent ob- 
served in the great European centers of population, but 
the difference in our favor is not so great that we may 
any longer point to it with pride; for my part, I confess 
that it is not apparent to me at all in the offspring of our 
city slum populace. When we consider the economic 
superiority of this country, its boundless material wealth 
and resources, its exemption from the military and social 
burdens imposed on the citizens of most foreign nations, 
we cannot but regard the conditions here as highly 
discreditable, and the general indifference on the subject 
still more so. It is idle for the optimist to protest that 
we are doing the best we can; a glance at the magnificent 
array of public institutions for children in France and 



CONSTITUTIONAL DISEASES 253 

Germany proves that we have done next to nothing, and 
have not even begun to display a proper amount of 
interest in that most important of all social questions, 
the health of our future citizens. It has, indeed, become 
impossible for us any longer to justify our neglect of 
those growing up among and about us, afflicted with 
chronic ailments that are almost untreated here, but 
would be handled with measurable success in certain 
countries that we like to regard as effete or decadent. 

While we were discussing the climatic management of 
the normal child in the preceding chapter, the thoughtful 
reader will surely have been tempted to question whether 
the children, repeatedly referred to as normal, are so in 
fact. I freely admit that the moderately subnormal 
child has been continually kept in view, and a moment's 
reflection will account for this apparently somewhat 
illogical position. The unpleasant truth is that our 
overwrought civilization has reduced the absolutely 
normal child, at any rate between the first dentition and 
puberty, to a mere theoretical quantity, an ideal to be 
steadily kept in mind and worked up to, but without 
undue expectation of ultimate realization. A normal 
breast-fed infant is not so great a rarity; artificially fed 
infants begin to deviate from the strictly normal in the 
first few weeks. When the child begins 'to run about, 
still more after it becomes introduced to life at school, 
it becomes exposed to so appalling an array of unhy- 
gienic influences and infectious diseases, that its eventual 
development into a healthy and robust adult is really a 
cause for astonishment. It is perfectly safe to say, 
without exaggeration, that in our large cities not one 



254 THE CLIMATIC TREATMENT OF CHILDREN 

child in ten, between the ages of six and fourteen, is a 
really first-rate physical specimen. We have learned to 
be content when children do not actually look or feel 
ill, and to overlook unwholesome pallor, deficient mus- 
cular vigor, or irregularity in the digestive functions; 
yet we feel that these children occupy the border line 
between health and disease. 

At puberty, very fortunately, nature is apt to come 
to our aid; there appears at that age a certain acceler- 
ated vigor of growth and assimilation which, in many 
cases, succeeds in overcoming previous physical defi- 
ciencies of minor degree, so that perfect hardiness may 
follow a somewhat delicate childhood, by the time that 
the eighteenth or twentieth year is attained. It is 
therefore justifiable for the family physician to hold 
out hope of the child's ultimately " outgrowing" its 
defects, when these are of moderate severity, even 
though such a promise rests on no well-established scien- 
tific basis. Matters do not, of course, always turn out 
so well; in many cases the mentioned physiological 
acceleration fails of full development, or is inadequate 
to overcome the preceding impairment of physique; in 
such an event the organism is in grave danger of a total 
breakdown. The age of puberty is therefore rightly 
regarded as a critical one; from it we may date a restora- 
tion to normal physical vigor on the one hand, or the 
succumbing to such affections as tuberculosis, neuras- 
thenia, hysteria, or chlorosis, on the other. It is need- 
less to observe that the final outcome, good or bad, 
depends largely upon skillful management, but in this 
the selection of climate plays a relatively small part, 
and we need not dwell on it further. 



CONSTITUTIONAL DISEASES 255 

. We thus see that the chapter on the normal child has 
become a discourse on the "almost normal," which does 
not suffer from any specifiable disease, yet enjoys a 
general state of health that is only moderately satis- 
factory. It is evident that we may pass all stages from 
the rather rare perfectly robust boy or girl, through 
every gradation, to children that are plainly in need of 
medical attention. Thus we arrive at the considera- 
tion of 

THE ERRORS OF NUTRITION AND DEVELOPMENT 

Simple Malnutrition. Simple malnutrition manifests 
itself primarily in a subnormal weight ; among concomi- 
tant symptoms the most striking is hyperesthesia to 
cold with a consequent tendency to what may well be 
called hibernation. The patient is decidedly apathetic 
and somnolent during cold weather, showing little 
physical and mental energy and requiring an abnormal 
amount of sleep ; this condition is in marked contrast 
to possibly normal activity when the weather is warm. 
Visceral torpidity is also quite regularly associated with 
malnutrition; the neuroses that are frequently present, 
and often in intimate relation with this physical state, 
may be reserved for separate discussion. The chief 
point in the last-named connection is the difficulty of 
estimating the time relation of the associated lesions; 
this problem is often complicated by such anamnestic 
data as a neurotic family history, or a record of exposure 
to undue strain at school or elsewhere; in many cases 
we undoubtedly witness the operation of a vicious 
circle. Then we have to exclude voluntary semi-star- 
vation on account of dental defects, disease of the 



256 



THE CLIMATIC TREATMENT OF CHILDREN 



naso faucial lymphatic tract, which regularly leads to 
this condition in time, if severe, and chronic digestive 
disturbances, due to improper diet or vicious habits of 
eating; under the last heading the bolting of food' may 
be due either to a mere bad habit, or again to defective 
teeth. 

Opinions differ widely as to the normal weight of the 
child ; • the various tables are derived from radically 
different material, and we are likely to err in our con- 
clusions, if we disregard racial variations. Three tables 
are here given, derived from Holt, Bowditch, Porter 1 
and Quetelet; 2 they differ so materially as to demand a 
few words of explanation. 



Age, 
Years 


Holt and Bowditch 


PORTEE 


Quetelet 


Height, 
Inches 


Weight, 
Lbs. 


Weight, 
Lbs. 


Height, 
Inches 


Weight, 
Lbs. 


1 

2 


29 
32 
35 

38 
41 
44 
46 
48 
50 
52 
54 
56 
58 
60 


20 
26 
31 
35 
40 
44 
49 
54 
59 
65 
71 
80 
90 
100 


42 

.47 
51 
56 
61 
67 
73 
82 
92 


27* 

30 

33 

36 

39 

42 

44 

46 

48 

50 

52 

54 

56 

58 


19 

24 


3 


28 


4 


32 


5 


35 


6 


38 


7 


41 


8 


44 


9 


49 


10 


54 


11 


60 


12 

13, 

14 . . 


65 

72 
80 







All these tables include clothing, amounting to about 
five per cent, of the gross weight; the variation accord- 
ing to sex never amounts to three pounds, at these ages, 
and may be disregarded. The enormous discrepancies 
among these tables are due to their origin. Bowditch's 
school children belonged to the gigantic Anglo-Irish 

1 Quoted from Holt. 2 Anthropometric, 1870. 



CONSTITUTIONAL DISEASES 257 

population at present inhabiting Boston, Porter's chil- 
dren were of the somewhat smaller Anglo-German popu- 
lation of St. Louis, whereas Quetelet's statistics are 
based on the rather undersized industrial population of 
Belgium, which is on the verge of the subnormal, if it 
has not actually crossed that line. According to my per- 
sonal experience any child falling at all below Quetelet's 
standard is suffering from malnutrition; even in the 
rather short-st.atured foreign, population of New York 
the normal children invariably register a proportionately 
greater weight than noted in this last table. 

The hyperesthesia to cold is highly characteristic. 
These children suffer severely from coldness of the 
extremities, even at moderately low temperatures, and 
complain of chilly sensations whenever the room tem- 
perature falls below 68 degrees. We have already noted 
that even normal children resist cold much more feebly 
than adults, but in the cases here mentioned the con- 
dition is extreme, and evident on mere palpation to 
an almost startling degree. Exposure to really cold 
weather, only a few degrees below; the freezing point, 
always causes a more or less severe congelation of the 
ears, nose, and extremities. We may mention, in pass- 
ing, that the outdoor temperature; at which severe 
freezing of the exposed ears or fingers of fairly normal 
adults may be expected, is about zero, and even a suc- 
cession of days near ten degrees fails to produce so great 
a crop of these accidents as follows one night of say five 
below zero ; in ill-nourished children, however, the crit- 
ical point is raised considerably, and the milder forms 
of frostbite may result from temperatures barely below 
the freezing point. Exposure to winds of the mistral 



258 THE CLIMATIC TREATMENT OF CHILDREN 

type of course facilitates this process, and the first vic- 
tims may appear as early as November, even in the 
middle latitudes of the United States. 

When organic disease and the neuroses can be excluded 
— the physician cannot be too careful on this point — 
we generally find one of two causes operating to produce 
general malnutrition. One is improper feeding, a com- 
mon and growing vice, particularly in our cities, where 
cheap confectionery supplies a ready means of under- 
mining the health of young children; in many cases the 
parents are equally to blame, in giving them such sub- 
stances as pickles, smoked meats, pastry, and other in- 
digestibles, besides poisoning them with tea, coffee and 
alcohol. These cases are usually amenable to dietetic 
treatment, provided that strict supervision be exercised. 
The second group of ill-nourished children have simply 
become enervated by overzealous care; they have been 
kept at home, usually in excessively warm apartments, 
even in fine weather, because the temperature ranged a 
trifle low; on their rare outings they have invariably 
been clothed too warmly in the cooler months, though 
often made victims of the bare-legs fad in summer. 
Such children are very apt -to fall a prey to respiratory 
disease at all seasons, and digestive disorders in summer, 
and the frequent recurrence of these ailments finally 
leads to a subnormal state in the intervals; these pa- 
tients are often ill, but seem never to become perfectly 
well. A subdivision of this second series consists of the 
victims of a succession of the infectious diseases, who 
have not had an opportunity to recuperate thoroughly; 
these children may be briefly described as chronic 
convalescents. 



CONSTITUTIONAL DISEASES 259 

It is hardly necessary to warn the practitioner that 
the picture of simple malnutrition, as just outlined, may 
be a mere mask for 'latent tuberculosis; even the laity 
seem to be aware of this relation. It is well to remember 
that lymphatic enlargement, especially in the cervical 
region, is suspicious; as is also a tendency to chronic 
catarrhal affections, whether of the respiratory or gastro- 
intestinal tract. 

From the above outline it is evident that, especially 
in the group I have designated as chronic convalescents, 
there is an extensive and profitable field of usefulness 
in climato therapy. Fresh air and, except of course in 
infancy, moderate exercise are the prime requirements ; 
the most suitable climate, therefore, is one that affords 
an abundance of fine days with a moderate temperature. 
In winter, a clear sky is, as we have seen, most readily 
obtained on the coast, where the temperature is also 
higher and more uniform than inland. Our Atlantic 
and Pacific Coasts, south of 'the fortieth parallel, also 
those of the Mediterranean Sea, to a far less degree those 
of the Bay of Biscay and the English Channel, supply 
these requirements in a general way; the two last-named 
are somewhat cloudy and stormy, forming the transition 
to the more northerly coasts, which are too rainy on the 
western, and too cold on the eastern sides of the conti- 
nents. As to the most appropriate temperature, some 
regard must be paid to the individual child. Great 
debility indicates a really warm resort, such as the 
Florida peninsula, which, though unsuited to invalids 
in general, may benefit the worst of these cases in mid- 
winter. Next comes southern Calif ornia, which is far 
more generally applicable; the warmest Mediterranean 



260 THE CLIMATIC TREATMENT OF CHILDREN 

resorts are but little inferior, unless in exceptionally 
cold and wet seasons. The Riviera, as well as our own. 
Southeast from Cape Hatteras to St. Augustine, call for 
but a slight degree of robustness; but Biarritz, the 
Pyrenees, the greater part of Italy, and most, of our 
southern pine belt, have a somewhat unsteady and cool 
winter climate, which is not congenial to children that 
are at all enfeebled. Yeo 1 very properly insists on mild 
resorts for at- least the early stages of convalescence; the 
Middle Atlantic Coast is therefore too cold and windy 
from December to March, the resorts of northwestern 
Europe are too cloudy and stormy, and the southern 
Alleghanies, as at Asheville, are too liable to sharp cold 
spells, as well as an excess of rain and snow, to be suitable 
to this group of cases, in whom anything like hardening 
is distinctly misplaced in the cold season. This is, how- 
ever, not the case when the child begins to recover its 
normal health and strength, but is still in some danger 
of. relapsing if returned home too soon; in this event 
the localities mentioned are useful as a sort of after-cure. 
In summer the little patient is likely to derive benefit 
from any resort that is neither positively enervating on 
the one hand, nor very elevated' or excessively cool on 
the other. Determann's 2 recommendation of high ele- 
vations in the Alps as a rest cure is intended for adults, 
and of doubtful advantage to them; Pearce 3 , who is quite 
thoroughly acquainted with our milder Rocky Moun- 
tain region, declares these elevations to be quite unsuit- 
able for this purpose; it is safe to say that situations 

1 See bibliography. 

2 Sammlung klin. Vortrage, 1901, No. 308. 

3 New York Medical Journal, Oct. 5, 1901. 



CONSTITUTIONAL DISEASES 261 

above three thousand feet are not good for children 
suffering from severe malnutrition or retarded con- 
valescence, as there is too much stimulation associated 
with residence in a highly rarefied atmosphere. Inci- 
dentally, the cold nights of the highest mountain resorts 
are of questionable benefit. We may acid that the colder 
and windier seaside stations are likewise too stimulating 
for ill-nourished children, especially those of tender age. 
Ide 1 recently remarked this in connection with the Ger- 
man seaside resorts, especially those on the North Sea, 
and Robin 2 warns us against excessive, exposure to the 
wind and sun on the north coast of France. Now, neither 
of these regions is especially sunny, but we find no diffi- 
culty in appreciating the force of the stated remarks if 
we spend a forenoon in the intense heat and glare that 
prevails on. the sands of our Atlantic coast on two sum- 
mer days out of three ; in the afternoon the sun shifts to 
the west, the reflection from the water and sand is less 
trying, and there is at least an even chance of a refreshing 
sea breeze. 

Powell 3 advises sea baths for these cases; he reports 
from Atlantic City, where the water is sufficiently warm 
on most summer days; unfortunately, the temperature 
at this resort is too high for the best results in July and 
August, except for feeble and very young children, for 
whom surf baths are inadvisable for reasons previously 
given. 

All in all, in treating ill-nourished ano! convalescent 
children the best results are likely to be obtained at 



1 Therapeutische Monatshefte, August, 1904. 

2 Archive general de medecine, July 21, 1903. 
8 See bibliography. 



262 THE CLIMATIC TREATMENT OF CHILDREN 

such localities as the moderately elevated inland dis- 
tricts of New England, New York, and Central Europe, 
where prolonged hot spells are uncommon, and the 
nights are almost always fairly cool. The chief object 
to be sought, in both summer and winter, is a mild tem- 
perature, with moderately abundant sunshine and free- 
dom from excessive dampness, fogs and high winds. It 
is evident that the greater part of North America between 
the Alleghanies and the Sierra Nevada is not especially 
suitable to children suffering from malnutrition or de- 
bility during the seasons of extreme cold and heat. 

In spring and autumn, particularly the latter, change 
of climate is of far less importance in the management 
of these cases, but northward March, often November, 
and occasionally April, are still somewhat raw and 
cheerless, entailing a restriction of outdoor life, and 
requiring a sojourn under milder conditions. Our pre- 
vious accounts render an extended discussion of this 
point unnecessary. 

Rickets. The rhachitic child presents some differences 
from the preceding, which call for somewhat different 
management. Rickets is, indeed, a form of malnutrition, 
but in this case the morbid process is not so generalized; 
certain tissues, notably the osseous and muscular sys- 
tems, suffer severely, whereas the body fat may be 
developed quite normally or even to excess. The great 
sensitiveness to cold, that characterizes our first group, 
is here far fro*m universal, being conspicuous only when 
the two conditions are combined as happens occasionally, 
in which event the above climatic suggestions likewise 
apply. 

In this connection, I must not fail to call attention to 



CONSTITUTIONAL DISEASES 263 

a very recent contribution by Hansemann 1 on the etiol- 
ogy of rhachitis, of special interest because of its bearings 
on our subject. Without ignoring the pernicious influ- 
ence of artificial feeding, he attributes this affection 
chiefly to what he aptly calls imperfect domestication; 
in other words, he regards man as not yet thoroughly 
adapted to an exclusively indoor life, and deems lack of 
fresh air in infancy to be the main cause of rickets. To 
substantiate this theory he adduces certain indisputable 
ethnological facts, for example, the rarity of rickets in 
Japan, where the poorer classes guard themselves most 
imperfectly against the vicissitudes of a fairly severe 
winter, and calls attention to the fact, most easily es- 
tablished, that the onset of this condition invariably 
occurs between November and April. The latter cir- 
cumstance I have taken the pains to verify by careful 
investigation, and it will not be out of place to add two 
more bits of evidence. First, I. have found that about 
one-tenth of the exclusively breast-fed infants in my 
service are rhachitic; inquiry showed that every one of 
them had been kept at home quite strictly, despite the 
uncommon mildness of the preceding winter. Secondly, 
every pediatrician in our northern cities has observed 
that negro and Italian children are the ones presenting 
this disease in its most severe forms. It happens that 
these are the two races most sensitive to cold, who 
protect themselves most carefully against our north- 
western blasts; we note, on the other hand, that the 
children of Russian parentage, economically perhaps the 
worst situated of all, present chiefly the milder forms of 
rickets, because this portion of the community is quite 

1 Berliner klin. Wochenschrift , Feb. 26, 1906. 



264 THE CLIMATIC TREATMENT OF CHILDREN 

used to severe temperatures in the winter months. In 
this connection I might also refer to the contributory 
influence of the tenement, evident from the remarks on 
housing made in the preceding chapter, and note the 
circumstance that, in New York at least, the apartment 
house, the tenement of the well-to-do, seems to be extend- 
ing the spread of rhachitis among the economically suc- 
cessful classes of society. 

As the last-najned condition is apparently beyond rem- 
edy, and sure in time to appear in most of our large 
cities, it behooves the physician all the more to use 
every climatic measure at his disposal to insure a suffi- 
ciency of fresh air to the infants in his charge. It is clear 
that the prophylactic methods, sketched out in the pre- 
ceding chapter, apply here most emphatically; in many 
cases, however, they will come somewhat too late to be' 
merely preventive, and resort to the procedures detailed 
below will become inevitable. In administering climatic 
treatment to rhachitic children, we must exercise a certain 
amount of discrimination, according to whether or not 
the patient is suffering from general malnutrition as well. 

The ordinary victims of rickets, of whom the typical 
representative is the " infant-food baby," fat and flabby, 
with a power of resistance far below that indicated by 
their general appearance, afford a relatively simple 
problem. These children are not especially intolerant 
of moderately low temperatures, but are highly sensitive 
to sudden changes, and do very badly if pampered to any 
degree. The first requirement naturally is an abundance 
of fresh air; rhachitic children may be taken out even in 
fairly cold weather, if bright and not too windy; they may 
also be subjected to such a mild process of hardening as 



CONSTITUTIONAL DISEASES 265 

is afforded by a daily -bath at a temperature of 86 to 88 
degrees in the second year, and a few degrees lower 
afterward. The sleeping apartment should be venti- 
lated as freely as is compatible with safety, and its tem- 
perature should be kept- below 70 degrees. Overheating 
and draughts are equally deleterious to these patients, 
whose respiratory tract readily becomes affected with 
obstinate catarrhal inflammation that may persist for 
months. 

In selecting a winter climate, we must materially 
modify the rules laid down before for ill-nourished chil- 
dren and those suffering from retarded convalescence. 
Such very warm resorts as southern Florida are invari- 
ably enervating and injurious in the long run, and 
therefore absolutely contraindicated. The cool seaside 
stations, such as those of the Middle Atlantic States and 
western Europe, are quite sure to prove of great benefit; 
they ? in vol ve just about the proper amount of hardening, 
if employed with certain reasonable precautions, such 
as the avoidance of fogs and high winds. The children 
may be given their daily airing even at temperatures 
below the freezing point, provided sunny and sheltered 
spots be chosen, and the amount of clothing be adequate. 
The enclosed solarium is immeasurably inferior in every 
way; it is almost always too warm and badly ventilated, 
and should be altogether reserved for very rough and 
cold weather. Its employment requires far more care 
than outdoor exposure, on account of the readily de- 
veloped combination of excessive warmth and draughts; 
the direct. rays of the sun, under glass, are as likely to be 
irritating as sedative, and their radiant heat is often 
sufficiently intense to be trying and harmful. 



266 THE CLIMATIC TREATMENT OF CHILDREN 

The solarium has gained favor for its supposed photo- 
therapeutic value; a moment's reflection will remind 
us of the purely empirical status of this idea, for it is not 
sustained by a single demonstrated case. In opposition 
to the employment of the solarium it is only necessary 
to refer to its close resemblance to the gardener's hot- 
house ; the mere comparison is sufficient to condemn it. 
Hardening may often be irrational, but hot-house treat- 
ment is quite indefensible; a more harmful procedure 
and one more certain to enervate the patient cannot be 
imagined. The solarium should be used as little as pos- 
sible, and reserved for special occasions and conditions, 
never employed in routine fashion; there is little purpose 
in inveighing against sending patients to the tropics, 
and then creating a tropical climate for them at home. 

Stations subject to violent storms, fogs, high winds, 
and a mean temperature below the freezing point cannot 
be recommended for even the fat rhachitic children. 
They involve too much hardening, and permit too little 
sojourn in the open air, to be altogether desirable, unless 
the difficulties and expense of transportation are a fac- 
tor, in which case even resorts that fall a little below 
the standard may be infinitely preferable to life in a city 
tenement. 

In summer, these cases invariably do best at cool 
resorts; the seashore has always been a popular refuge, 
and tepid sea-water baths add a valuable feature, the 
surf being, of course, unsuitable to the very young. 
Rhachitic children of three years or more may, however, 
be taken into the ocean at low tide at our Middle Atlantic 
resorts, where the water frequently has a temperature 
exceeding 70 degrees; it need hardly be said that this 



CONSTITUTIONAL DISEASES 267 

experiment must be made cautiously, on a day when 
the air is warm and the water also warm and relatively 
quiet, and not repeated if the child fails to react well. 
The custom, common in this country, of permitting . 
young children to remain in the water until they become 
cyanotic with cold, is highly reprehensible, and may 
entail prolonged invalidism to a delicate or rhachitic 
child. The extreme time limit for the first dip should 
be one or two minutes, which may be extended to five 
minutes under exceptionally favorable circumstances, if 
the baths seem to benefit the patient. 

Unfortunately, the resorts that permit much ocean 
bathing are often too warm for the best results; even 
the New Jersey and Long Island coasts are a little ener- 
vating, and the general climatic conditions are better on 
the coasts of New England, the English Channel, and 
the Baltic. Along the North Sea the summer is perhaps 
a little raw, as it also is in extreme eastern Maine and the 
coldest stations of the Maritime Provinces, but fairly 
hardy rhachitic children do very well in these regions 
likewise, though the low temperature of the ocean pre- 
cludes sea bathing. The southwest coast of France has 
a moderately cool summer, with a few hot days, the 
water being fairly warm; southern California is very 
similar on the immediate coast, but too cool on the 
islands and north of Santa Barbara, too warm even a 
short distance inland. The cooler stations in the Lake 
Region are not so very different, but lack the fresh salt 
air and the opportunities for saline baths; the latter 
deficiency, at least, seems to be of some moment, and 
these resorts form a sort of transition to the inland dis- 
tricts of low or moderate elevation. 



268 THE CLIMATIC TREATMENT OF CHILDREN 

Rhachitic children do well at the inland localities 
recommended for the generally ill-nourished, but may 
often safely be taken to higher altitudes, where the 
Swiss observers note excellent results. It is, however, 
a little too cool in the Alps at elevations above 3,000 
feet, and the far warmer, yet still bracing, Rocky Moun- 
tain stations seem to me to offer very superior summer 
conditions. Here, too, I would advise some modera- 
tion in the matter of altitude, and set the limit pretty 
strictly at 6,000 feet, for higher up the rarity of the 
atmosphere and the intense insolation are a little too 
stimulating. 

The climatic management of rhachitic children requires 
the exercise of considerable discretion; and the combina- 
tion of rHachitis with malnutrition indicates a compromise 
treatment, involving a minimum of hardening at the 
outset, until the weight of the patient reaches the normal, 
when a more strenuous regimen may be inaugurated, 
beginning gradually. It is needless to say that individ- 
ualization and continuous and intelligent medical super- 
vision are necessary to insure the best results; leaving 
the matter to the parents and their inexpert management 
is sure to entail a large proportion of failures, whereas 
marked improvement is almost invariably obtained in 
sanatoria. It is to be understood, of course, that prog- 
ress is never rapid; the minimum duration of a cli- 
matic cure should be three months, and longer periods, 
up to a year, show a proportionate benefit. 

It is a lamentable fact, here as elsewhere, that our 
knowledge on this subject is derived almost entirely from 
foreign sources; winter sanatoria for rhachitic children 
hardly exist in this country, and retreats for the summer 



CONSTITUTIONAL DISEASES 269 

are adapted to a stay of two or three weeks only, a period 
too short to benefit these cases materially. The chil- 
dren of our poor population are practically quite neg- 
lected in this respect; our resources are largely limited 
to the families of the well-to-do, among whom rickets is 
not so very common, and rarely severe. 

Ancemia. Most cases of anaemia in young children 
are merely phases of the two preceding affections; to- 
ward puberty, however, we begin to encounter cases of 
genuine chlorosis, and some of the anaemias of infants 
show a strong tendency to take on a pernicious form. 
Morse 1 properly, as I think, considers the types known 
as splenic anaemia, infantile pseudoleukaemic anaemia 
(v. Jaksch), and related forms as merely the infantile 
expression of anaemias that would present less severe 
symptoms in older subjects. Apart from merely theoret- 
ical considerations, however, the gravity of certain anae- 
mias in tHe very young is evident from the microscopic 
revelation of such serious changes in the blood elements 
as cannot very well be refuted. We may therefore con- 
fidently take the stand that a routine application of 
methods suitable to adult anaemias is out of place in the 
treatment of children. 

The effect of high altitudes, and for that matter, more 
moderate ones, on the haematopoietic system, was dis- 
cussed thoroughly in the introductory chapter. The 
therapeutic value of this physiological adaptation has 
been canvassed with some care, and such authorities 
as Lazarus 2 and von Noorden 3 have convinced themselves 



1 Boston Med. and Surg. Journal, May 28, 1903. 

2 Die Anamie. Nothnagel, spez. Pathol, u. Therapie, vol. 8. 

3 Die Bleichsucht. Ibid. 



270 THE CLIMATIC TREATMENT OF CHILDREN 

of the stimulating effect of elevations, up to 6,000 feet, 
in cases of chlorosis as well as secondary anaemia, claim- 
ing that the required increase in erythrocytes and 
haemoglobin is fostered by the greater demand of the 
body for oxygen at the high levels. It will be noted, 
however, that the former author sets the limit for severe 
cases at 3,000 feet, and that the latter thinks such high 
plateaus as the Engadine ' more valuable as a prophy- 
lactic against exacerbations and relapses, than as a 
cure for advanced cases. Determann 1 distinctly warns 
against sending sufferers from severe anaemia to the 
loftier Alpine stations, the same is the opinion of Weber, 2 
who, indeed, believes the change of air and scene to be 
perhaps as potent a curative factor as the mere altitude. 
It will be as well for the reader to bear in mind that the 
above observations chiefly relate to young adults who, 
even when seriously anaemic, are less enfeebled than 
young children suffering from the extreme degeneration 
of the blood that we occasionally meet with ; the French 
physicians, as Huchard, 3 are almost unanimous in object- 
ing to altitudes above 3,000 feet in treating anaemic 
children. Except in individual cases of girls near pu r 
berty, we rarely encounter primary anaemia of the chlo- 
rotic type in children; nearly every case is secondary 
to general malnutrition or some wasting acute or chronic 
disease, entailing other phases of debility; what these 
patients need, above all, is rest, not stimulation, and 
certainly not the excessive stimulation inevitable at 
high elevations. 

1 Loc. cit. . 

2 See bibliography. 

3 Bulletin general de therapeutique, 1897, No. 5. 



CONSTITUTIONAL DISEASES 271 

The same authors, for analogous reasons, plead against 
sending such children to the rougher and colder type of 
marine climate, where they are apt to suffer from cold 
and raw winds, and frequent changes of the weather. 
On the other hand, they all agree in praising the milder 
seaside resorts, such as the Riviera in winter, and the 
west coasts, of France in summer; as a matter of fact, 
they consider the indications in the anaemia of children 
to be closely similar to those in rickets, namely, mildly 
stimulating, . but not enervating. 

I feel that the subject cannot be dismissed quite so 
summarily; individualization is far more needed than 
in those cases of simple rickets where the general nutri- 
tion is fair to good. The severe anaemias more closely 
resemble our first group of 'cases, which present mere 
emaciation without noteworthy haemic changes. It is so 
all-important to conserve the feeble energies of severely 
anaemic infants and young children, that I would un- 
hesitatingly advocate relatively mild measures. These 
grave cases are regularly, though not by any means 
invariably, characterized by the presence of nucleated 
red blood cells; in the event of such a finding I would 
begin with a distinctly warm climate, such as south 
Florida in winter, the Carolina lowlands in spring, and 
New Jersey in summer; none of them warm enough to 
enervate rapidly, yet so mild as to spare the general and 
haemic metabolism. When the patient has improved so 
far that the erythrocytes present at the most a moderate 
poikilocytosis, and the percentage of haemoglobin has 
reached about 60, a more strenuous regime may be in- 
augurated. Naturally, milder anaemias, especially after 
the third year, may be handled more rigorously from 



272 THE CLIMATIC TREATMENT OF CHILDREN 

the very first, in fact, very much like rhachitic cases 
of the feebler variety; moderately anaemic, fairly robust 
and older children seem to do better in the mountains 
than at the seashore. It is, however, evident that alti- 
tude, as such, plays a rather unimportant part; the 
benefit achieved is mostly derived from the life out of 
doors and the pleasantly low temperature; therefore 
such regions as the Catskills and White Mountains are 
in every way preferable to the excessively stimulating 
conditions in the Rockies, or the April-like weather in 
the high Alpine valleys. 

The wisest plan, in every case, is to treat the patient 
first, and regard the disease as secondary, which, indeed, 
it usually is. There is no climatic specific for the 
anaemias of children, and the general condition is our 
best guide in almost every case. 

The treatment of chlorosis, sometimes seen in girls 
near puberty, should be along similar lines; the climatic 
treatment is an admirable adjuvant to the administra- 
tion of iron, and may be applied very much along the 
lines just laid down for secondary anaemia. Only the 
bad cases, with less than 3,500,000 erythrocytes, should 
be sent to warm regions, and such as show merely a 
diminution of the haemoglobin, with hardly any reduc- 
tion of the cellular elements, may be referred to the 
mountains, at fairly high elevations, according to the 
principles before enunciated. 

Climatotherapy has also been applied to the treatment 
of leukaemia, but it is doubtful if any real benefit is 
derived, especially when we recall the indistinct border 
line between anaemia and leukaemia in childhood; the 
question of a correct diagnosis is not always soluble. 



CONSTITUTIONAL DISEASES 273 

Hoessli's 1 claims of success at St. Moritz cannot be 
accepted as conclusive; he regards the upper Engadine 
a little too much in the light of a panacea to be quite 
convincing; we all know that this affection is subject to 
spells of improvement under any rational regimen, and 
must regard his view with justifiable skepticism. 

SYSTEMIC DISEASES 

Under the heading of systemic diseases we are com- 
pelled to include a heterogeneous lot of affections which 
are not purely nutritional or developmental, nor, on the 
other hand, to be always classed among the infections, 
though in some cases certainly belonging to the latter 
group. For our purposes, it will not be necessary to 
adopt the most recent pathological theories, which did 
not yet exist when fairly good elimatotherapeutic reports 
were already abundant. Only such of these affections as 
are amenable to this method of treatment will, of course, 
be considered here, a reference to all would involve an 
unnecessary waste of space and time. 

Rheumatism and the Rheumatoid Diseases. The treat- 
ment of chronic articular and muscular rheumatism 
may be taken up at this point, for want of a better; the 
miscellaneous lot of affections called rheumatoid may 
be appended to rheumatism proper, for the climatic 
therapeutics of all are practically identical. The sub- 
ject, as a whole, presents relatively few theoretical 
difficulties," but our results are rather apt to fall short 
of our aims, for a variety of reasons, some of which will 
appear presently; the chief one is a certain inadequacy 
of all our physical methods as applicable to this group. 
1 Therapeutische Monatshefte, November, 1904. 



274 THE CLIMATIC TREATMENT OF CHILDREN 

The main desiderata are warmth and dryness. Since 
exercise is, from the very nature of these ailments, either 
impossible or very limited, the patient can remain 
out of doors only under very favorable meteorological 
conditions; furthermore, few affections are influenced 
so unfavorably by chilliness, dampness, and sudden 
changes, among which a rapid fall of the atmospheric 
pressure seems to rank first. This last feature is curious 
and hitherto unexplained, though a matter of almost 
daily observation. The return or exacerbation of the 
often excruciating pains begins at the first sign of a 
change in the weather from fair to bad, while the humid- 
ity is still low; it is, in fact, apt to be unusually low on 
such an occasion. The pains almost always remit as 
soon as the barometer begins to rise, although the atmos- 
phere may still be saturated with moisture at the time. 

In winter we do well to select a subtropical and arid 
region such as Arizona or Egypt, with southern Cali- 
fornia as a good second choice. Nearly all the remaining 
southern stations are too moist to be quite satisfactory", 
even when sufficiently warm. We have noted the im- 
possibility of compensating for a low temperature by 
means of exercise; it is therefore quite essential that the 
afternoon temperature at the resort selected should av- 
erage between 65 and 75 degrees; a survey of our cli- 
matological tables shows that few places combine this 
requirement with dryness and abundant sunshine, those 
just mentioned being practically all. It is clear that 
the management of a sufferer from chronic rheumatism 
or rheumatoid disease is apt to be unsatisfactory in 
winter, if the means for a journey of some thousands of 
miles are not available; it is, indeed, just about as well 



CONSTITUTIONAL DISEASES 275 

to keep the patient in his comfortable home, where good 
medical attendance is at hand, as to send him to some 
damp and changeable mountain spa, where the expected 
benefit from a course of baths is quite sure to be neutral- 
ized by adverse weather conditions. Even the mildest 
of these resorts, such as Hot Springs, Ark., and the 
Pyrenean stations, have a distinctly third-rate winter 
climate, most of the others are altogether unsuitable at 
that season; their usefulness is limited to the period 
from April or May to October or November. At such 
southern stations as Hot Springs the summer is intol- 
erably warm and oppressive; most of the other spas 
are very pleasant in summer, when the combination of 
baths and climate is likely to benefit many of our pa- 
tients, but not all. The more intractable rheumatic 
cases are a sore trial to the patience and ingenuity of the 
most experienced and conscientious attendant; total 
or partial failure of climatic, as well as other treatment, 
is regrettably frequent. 

We may here enter on a brief review of the relatively 
numerous summer resorts with a good or fair climate. 
The Rocky Mountain region is very dry and fairly 
warm in the more southerly sections ; Glenwood Springs, 
Col. (5,770 feet) seem fully^ to deserve their growing 
reputation, Las Vegas Hot Springs, N. M. (6,770 feet), 
are also well spoken of, but perhaps a trifle too elevated 
for some subjects; wind and dust are likely to be the 
worst features .in this section. Banff Hot Springs, 
Alberta (4,540 feet), has a summer like that of the 
upper Alps, and is rather' cold for young children. The 
lower inland resorts in the northern United States, 
Canada, and central > Europe are dry enough for our 



276 THE CLIMATIC TREATMENT OF CHILDREN 

purposes, provided remoteness from large bodies of 
water be secured. In this country Mt. Clemens, Mich., 
in spite of some little exposure to lake breezes, seems to 
rank highest; the various springs in central New York 
are perhaps not quite so good. The climate of Hot 
Springs, Va., is already a little too warm in midsummer, 
and Hot Springs, N. C, and the resorts of southern 
Indiana are intolerably hot at that season. 

The seaside and the Great Lakes are distinctly to be 
avoided, and even small lakes, in a thickly forested 
region like the Adirondack Mountains, are the cause of 
much dampness at night. Densely wooded tracts are 
always excessively moist after rainy spells, and deep 
valleys are subject to night fogs in quiet weather, even 
if the days have been quite dry. Open plateau sites 
and mountain slopes, especially such as face south and 
west, where the drainage of both water and air are good, 
are far more desirable. 

Among inland European resorts our choice is even 
less limited; almost all those north of the Alps, less 
than 3,000 feet high, have a fairly good summer cli- 
mate, and at the various bathing places the medical 
attendance is far superior to that found at most of our 
spas. Without referring more than casually to certain 
practices at such places as Hot Springs, Ark., many of 
our best resorts are frequented by practitioners of in- 
ferior caliber; it is one more instance to be added to the 
long roll of wasted opportunities on this continent. 
Meanwhile our invalids spend millions of dollars in 
Europe to obtain what should be quite as available on 
our side of the Atlantic. 
. Summer resorts with afternoon temperatures running 



CONSTITUTIONAL DISEASES 277 

much below 70 degrees are to be avoided, but only the 
higher Alpine stations are objectionable on this account; 
the relative inability to take exercise must be taken 
into consideration. Enervation should be guarded 
against carefully; it is difficult to avoid, in view of the 
inactive life of rheumatic patients, and the only sure 
method is to avoid places and seasons with an aver- 
age day temperature much above the indifferent point, 
somewhere near 75 degrees, unless there is compensat- 
ing coolness at night. In our eastern states few inland 
stations south -of New York and New England fulfill 
this requirement in July and August; Europe is much 
better equipped in this regard, as every locality north 
of the Alps, including even the ■ warmer valleys, is 
available. 

The reader will naturally understand that any such 
complications, as valvular heart disease or chorea will 
call for a material modification of the above recommen- 
dations, and will especially contraindicate the high alti- 
tudes in very many cases. For precise details we must 
refer to the paragraphs that treat of those affections; 
the relatively simple rules that guide us in the manage- 
ment of uncomplicated rheumatism now give way to a 
far more involved situation. 

The seashore is almost universally deemed unsuitable 
for rheumatic patients ; still a few authorities, among 
them Yeo, claim to have observed improvement in cer- 
tain very chronic forms of rheumatism at marine sta- 
tions, and also look with favor on the employment of 
warm sea- water baths. With regard to the climate, 
the exception Yeo refers to is in a measure only appar- 
ent, for, as we well know, certain seaside localities, like 



278 THE CLIMATIC TREATMENT OF CHILDREN 

southwestern California and some Mediterranean points, 
are drier in winter than the near-by inland districts; this 
does not by any means apply to coastal climates every- 
where, nor at all seasons. Again, we must remember 
that there are good and bad seasons at the seashore as 
elsewhere; even so moist a region as the south shore 
of Long Island may be fairly dry in exceptional years, 
when land breezes are unusually frequent. It will, 
however, be found a safe rule to avoid the coasts, with 
the possible exception of the two mentioned above; a 
really oceanic atmosphere is certainly not good for the 
victims of rheumatism in any form, the sea breeze and 
fogs being ' decidedly harmful. Saline baths can be 
given with nearly equal ease and greater benefit at an 
inland resort. 

The Hcemorrhagic Diseases. Under this heading we 
£re obliged to throw together a series of quite unrelated 
affections, which, nevertheless, require similar manage- 
ment with regard to climate. Purpura rheumatica calls 
for the same treatment as the other rheumatic diseases, 
only chronic cases, of course, coming under consideration 
here. Scurvy is so amenable to specific treatment that 
climatotherapy is quite subordinate, and applies only to 
the secondary anaemia. The curious affection known as 
paroxysmal hemoglobinuria, however, is worthy of a 
few detailed remarks in this connection, since it is, to a 
certain extent, a condition depending upon climatic 
influences. To understand this more- fully, it will be 
necessary for us to consider some etiological points. 

Attacks of paroxysmal hsemoglobinuria seem to de- 
pend upon the combination of two factors, namely, pre- 
disposition, and exposure to a low temperature; various 



CONSTITUTIONAL DISEASES * 279 

constitutional diseases may come under the former 
head, notably congenital syphilis; in many cases, how- 
ever, the predisposing cause is not ascertainable. As to 
the exciting cause, the evidence is ample; thus, among 
recent cases, Homberger 1 reports a boy of ten years, 
who developed an attack from falling into the river in 
the cold season; Burckhardt 2 showed that cold alone 
could bring on a spell, but that constriction of a limb 
increased its severity. Chvostek 3 differs from the pre- 
ceding in considering the coincidence of cold and 
traumatism (in the broadest sense) essential, whereas 
Donath 4 considers a low temperature alone sufficient. 
Cold, or at least a chill, seems at any rate to be the 
essential exciting factor. I do not think it advisable, 
in this connection, to enter on a discussion of the more 
minute pathology of this curious and somewhat uncom- 
mon affection, especially as the authorities have not as 
yet come to a definite conclusion; the reader is referred 
to the. last three articles for further information. 

Sufficient has been said to furnish the climatothera- 
peutic indication, namely, to send the patient to the 
mildest and most even climate available, stopping just 
short of the tropics in winter, and such very warm and 
moist regions as our southern states in summer. The 
drier heat of the Mediterranean countries and our South- 
west is not very enervating, and may result in benefit. 
Yeo recommends Madeira, which is equable, and not 
too enervating in summer; Bermuda is similar in winter, 

1 Zeitschrift fur klin. Medizin, vol. 53. 

2 Jahrbuch fur Kinderheilkunde, vol. 57. 

3 Ueb'er das Wesen der paroxvsmalen Hamoglobinurie, Leipzig 
u. Wien, 1894. 

4 Zeitschrift fur klin. Medizin. vol, 52, 



280 THE CLIMATIC TREATMENT OF CHILDREN 

but the summer is certainly too hot and moist; his 
recommendation of the West Indies in winter is to be 
accepted cautiously, but the relatively cool and dry 
stations, such as the hill country of Jamaica, north- 
western Cuba, the uplands of . Porto Rico, and the 
Bahamas,, may be tried, at least for one season. .Key 
West, outside of the tropics, but with practically the 
winter climate of Havana and Nassau, has a particularly 
even temperature, except when a norther springs up, 
and the rainfall is very small from December to March. 
In summer, the lowlands of the Middle Atlantic States, 
excepting the hottest places, such as the lower Delaware 
Valley, also the resorts of the southern Alleghanies, 
afford a good climate; the best stations of California, 
away from the immediate coast, but not too far inland, 
are excellent for this purpose, Los Angeles and its 
vicinity may safely be recommended. In Europe, I 
would select the southern slope of the Alps, including 
the Lake of Geneva and southern Tyrol, but avoiding 
such very low-lying stations as Riva, which has an 
altitude of only 300 feet, and a July temperature like 
that of central New Jersey and the lower river valleys 
of Pennsylvania. Among foreign winter resorts, Ma- 
deira, as stated, and upper Egypt are by far the best; 
in this country Florida leads, southern California comes 
next, all the others are inferior. 

Amyloidosis. Amyloid degeneration of the various 
cellular organs usually follows chronic suppurative 
processes in children, rarely congenital syphilis (Osier), 
in contradistinction to its frequent sequence to acquired 
lues, and is a subject for climatic treatment in an 
exquisite degree. The prognosis of amyloidosis is not 



CONSTITUTIONAL DISEASES 281 

quite so unfavorable in the young, as in older subjects, 
and a consistent attempt with climato therapy, the only 
procedure of any great value, is always well worth the 
making. 

The most important, and the majority, of these cases 
follow in the train of a chronic tubercular affection, 
usually of the bones; the chief interest lying in the cir- 
cumstance that the detection of even an early stage of 
this serious degenerative process calls for an immediate 
abandonment of the hardening regime that is usually 
so essential a feature in the management of tne primary 
disease. The victim of amyloidosis urgently demands 
a warm and dry climate; the brisk sea and mountain air 
that so greatly benefits the uncomplicated tubercular 
osteitis, becomes exceedingly harmful when this com- 
plication has developed, and the patient now requires 
prompt transfer to a milder climate, though that may 
have a less favorable action on the underlying process. 

The organs in which amyloidosis is regularly first 
detected, and in which it is of the most serious conse- 
quence for the organism as a whole, are the kidneys; 
the clinical picture of amyloidosis, in fact, closely re- 
sembles that of a chronic diffuse nephritis in its more 
dangerous stages. This happens because amyloidosis 
is rarely detected before it is well advanced, its symp- 
tomatology being largely masked by ■ the underlying 
condition and the albuminuria which is so common in 
chronic febrile affections like tuberculosis; a previously 
existent nephritis, of mild degree and not seriously 
regarded, naturally aids in masking the earlier stages of 
amyloid degeneration. 

The treatment of this affection, as would be expected, 



282 THE CLIMATIC TREATMENT OF CHILDREN 

approximates closely to that of the severer forms of 
chronic Bright's disease; progress is therefore slow, so 
that the curative process, if at all attainable, is likely to 
extend over a series of months or even years. This may 
not appear very important, inasmuch as the primary 
affection is also excessively chronic, but we must bear 
in mind that only very few climates are really beneficial 
to these subjects, and that the prognosis is dubious at 
best; thus enormous sacrifices may be imposed on the 
patient's family, and turn out to be fruitless after all. 
The only method that really commends itself is a stay 
at an appropriately situated sanatorium for a year or 
more, an expedient within the reach of only the very 
well-to-do in this country, where sanatoria for poor 
children are almost non-existent. "They order this 
matter better in France." 

For the various climates suitable to the treatment of 
amyloid disease the reader is referred to the paragraphs 
on chronic nephritis. The recommendations there 
worked out in detail apply here even more forcibly, the 
only very important differences being in respect to the 
duration of treatment and, unfortunately, too often in 
the prognosis. 

Congenital Syphilis. Severe cases of hereditary syphilis 
may derive great benefit from a change of climate; the 
guides we should follow are symptomatic. Thus, the 
management of the individual case will vary according 
to whether a severe anaemia of the von Jaksch type, or- 
intractable gastro-intestinal symptoms, or a state of 
lymphatism, or visceral degeneration dominates the 
picture. While this disease, in the adult, is conspicu- 
ously amenable to specific medication, this is true to a 



CONSTITUTIONAL DISEASES 283 

far less degree in children of a tender age. Babies, in 
particular, often thrive but poorly in spite of most 
intelligent mercurialization; even if they gain some in 
weight and become free from all demonstrable lesions, 
they often remain subnormal in health and subject to a 
recurrence of symptoms. In addition, some of the worst 
cases are not very tolerant of the specific drugs ; anaemia 
a'nd other forms of malnutrition are apt to develop and 
menace the patient's life very seriously. 

There is therefore a considerable proportion of syphi- 
litic infants and children who require tonic treatment 
quite as much as mercury and the iodides, and one of 
our best tonic measures is removal to a temperate cli- 
mate. The best temperature for the winter is as low as 
is consistent with a life out of doors, higher, therefore, in 
the very feeble than in those in a state of fair nutrition; 
in this matter the physician may be called upon to 
employ no little judgment. In the warmer months the 
seaside has long been regarded as the sovereign remedy, 
including warm salt baths for infants and cooler ones 
for older and more robust children. For the latter 
the milder mountain resorts have hardly received their 
due meed of attention, and I think they merit a more 
extended trial than they have had hitherto. Older 
children, in whom moderate general malnutrition and 
anaemia are practically all the lesions that concern us, 
often require considerable toning up; I would not 
hesitate to send them to the more bracing resorts of the 
Alps or Rocky Mountains, or the colder hill stations of 
our northeastern states. 

Malaria. Although so exquisitely a climatic disease, 
malaria is only indirectly amenable to treatment by a 



284 THE CLIMATIC TREATMENT OF CHILDREN 

change of air. In the direction of prophylaxis, the 
selection of a suitable climate is of course paramount, 
but in an established case departure to a non-malarious 
region has more effect on the secondary manifestations, 
such as the anaemia, than on the protozoa in the blood 
and viscera, which must be combated with quinine and 
arsenic in the usual way. So slight is the direct curative 
effect of a cool climate on the disease itself, that the 
mere trip to such a region may bring on an attack where 
the affection has remained latent, the exciting cause 
probably being a slight chilling on a cool night; it is 
well known that paroxysms are apt to be provoked by 
exposure to cold or wet. 

Nevertheless, our first move in the management of a 
case of malarial fever or masked malaria, aside from the 
specific medication, must be removal to an immune 
region, on this continent any- locality with an average 
July temperature below 66 degrees; in this way, at any 
rate, we guard the patient against reinfection. As to 
eradication of the disease, we can hold out no promise 
as the result of such a journey; the total destruction 
of the parasite must, apparently, be effected by drugs 
in most instances; the action of climate is merely auxili- 
ary, but I doubt if it can be considered specific in any 
sense, so far as a once infected individual is concerned. 
The spread of the disease to uninfected individuals 
is, of course, obviated by recourse to an antimalarial 
climate. 

Malarial cachexia is also a fit subject for medical 
climatology, but the indications here are quite different, 
being in general those discussed under the title of nutri- 
tional diseases. In no case, however, may we select a 



CONSTITUTIONAL DISEASES 285 

region not absolutely free from the malarial parasite; 
some of the very mild winter climates, notably that of 
the Florida peninsula, that might possibly be chosen for 
extremely debilitated cases, with marked hepatic and 
splenic enlargement, are therefore to be rejected. In 
mild seasons, there is some malaria in the region named 
throughout the winter, for, as previously noted, killing 
frost visits southern Florida only about every third year, 
and then for only a day or two at a time. Otherwise, 
the principles laid down for malnutrition and severe 
anaemia hold good; the precise application of climato- 
therapy to the individual depends on the symptomatic 
indication. 



CHAPTER VI 

VISCERAL DISEASES 

The climatic treatment of disease in any single organ 
or group of organs usually involves a careful balancing of 
the relative importance of the local lesion on the one 
hand, and the patient's general condition on the other; 
only in exceptional cases are we called upon to direct 
our treatment to any one symptom. This is, of course, 
inevitable, for climatotherapy, as already stated, is so 
general a method, that its strictly local application is 
impossible, and its effect on the body as a whole must 
always be kept in view. The importance of maintaining 
this attitude is sufficiently great to warrant its repetition 
here, even at the risk of appearing wearisome. 

There are, however, a few exceptions to this broad 
rule, where certain climatic affections are concerned; we 
may add that these constitute about all the instances in 
which acute organic ailments come within our scope. 
In visceral disease, in general, the domain of climato- 
therapy is almost limited to chronic affections, nearly 
all of which are, however, included; it may be said, 
without exaggeration, that there are few of them that 
cannot be ameliorated by an appropriate climate; in a 
considerable number all other therapeutic procedures 
become of minor consequence. It is, for this reason, 
not remarkable that the present chapter, in spite of 
extreme and possibly excessive condensation, is rather 

286 



VISCERAL DISEASES 287 

long, merely because of the very wide range of subjects 
presented for discussion. 

DISEASES OF THE UROPOIETIC SYSTEM 

Albuminuria. The occurrence of albuminuria without 
any demonstrable renal lesion is now quite generally 
accepted; it is variously designated cyclic, orthostatic, 
or adolescent, all of which terms are more or less descrip- 
tive of the circumstances under which it is encountered. 
In addition, many persons develop this disquieting 
symptom after excessive muscular exercise or very cold 
baths. As cold bathing plays an important role in the 
hardening regime, as well as in general physical thera- 
peutics, a few words on this phase of the subject will not 
be amiss. Rem-Picci 1 has made a series of investiga- 
tions, on adults, it is true, which show that albuminuria 
may follow an immersion of fifteen minutes in water at 
60-68 degrees, and a three-minute dip at 54-56. In 
robust persons, who did not excrete albumen after warmer 
baths, the albuminuria was transitory, disappearing 
within twenty-four hours; we cannot help thinking, 
however, that frequent repetition of such baths may 
sometimes result in a permanent condition of the cyclic 
or orthostatic type, if not true renal disease. The same 
apprehension exists in cases where albuminuria appears 
after violent exercise, as indulged in by athletes; here 
also we may justly dread the eventual development of a 
chronic disorder. 

At this point it can do no harm to remind the reader 
of the series of animal experiments detailed in a previous 
chapter, in which chilling the surface of the body plays 
a leading part in causing albuminuria, and to recall the 

1 II policlinico, 1901, No. 53. 



288 THE CLIMATIC TREATMENT OF CHILDREN 

relatively feeble resistance of children to adverse influ- 
ences of this kind. 

If we omit such albuminurias as are altogether transi- 
tory from present consideration, I feel that we are bound 
to agree with Senator 1 that we cannot exercise too much 
caution in regarding the remaining cases as compatible 
with absolutely normal renal tissues. Surely, it is not 
a pure coincidence that cyclic or orthostatic albuminuria 
is particularly frequent in the train of scarlatina and 
diphtheria, and no experienced practitioner will be mis- 
led by the fact that the infectious disease may have 
preceded the first positive demonstration of albumen by 
months or even years. It is sufficient for us to remem- 
ber that chronic nephritis may develop most insidiously, 
escape observation during its early stages, and finally be 
revealed quite casually in the routine urinalysis which the 
physician is in duty bound to make periodically for every 
one of his patients. Continued and precise investiga- 
tion will show that these patients quite regularly excrete 
a trace of albumen during the waking hours, especially 
if muscular exercise is freely indulged in, though the 
urine passed on rising is normal. If such a patient pre- 
sents, in addition, what the experienced practitioner 
learns to recognize as the nephritic habitus, the case 
should be regarded as highly suspicious with respect to 
the presence of a true organic lesion. In this connection 
it is both interesting and important to note the obstinate 
persistence of these traces of albumen; they are pretty 
certain to continue for months, and extension of this 
abnormality over a still longer period makes the eventual 
diagnosis of true chronic nephritis almost unavoidable. 

1 Nothnagel, specielle Pathologie u. Therapie, vol. 19, part 1. 



VISCERAL DISEASES 289 

In view of the above array of facts, the treatment of 
cyclic or orthostatic albuminuria becomes identified with 
that of chronic nephritis. We may indeed go further, 
and insist on the relatively greater importance of 
properly managing the former; for, if it is desirable to 
reduce so dangerous a lesion as. nephritis to comparative 
innocuousness, even when there is no prospect of a 
real cure, it is infinitely more necessary to wage an 
active campaign against what may be its early stages 
when the prognosis is very much more hopeful. As 
to the precise methods, however, we may content our- 
selves with those to be recommended for nephritis as 
fully established; the differences in managing albumin- 
uria alone are quite trivial, and will be touched upon 
below. 

Nephritis. Acute and subacute nephritis are empha- 
tically subjects for home treatment, but the chronic 
forms of Bright's disease form an attractive and profit- 
able field for clima to therapy; there are indeed few dis- 
eases that are so likely to undergo improvement upon 
removal from a severe to a more genial climate. The 
main indication is already clear from our discussion of 
albuminuria; it consists in the avoidance of cold, espe- 
cially when combined with dampness. The choice of 
a warm and dry climate is not, however, limited to the 
above-outlined aims, which are in a measure prophylactic; 
it is also intended to favor a species of physiological 
readjustment, which has always invited the attention of 
therapists. 

In treating nephritis, it has been for centuries a recog : 
nized principle to spare the diseased organs as much 
as possible. , This indication is met most readily by 



290 THE CLIMATIC TREATMENT OF CHILDREN 

throwing as much of their work as possible upon those 
excretory channels that can vicariously assume a portion 
of their duties. Although the kidneys, as is now generally 
accepted, do not constitute mere filters, yet, in a certain 
broad sense, the filtration of the blood is their chief 
function; their contribution to metabolism is less essen- 
tial, though we must admit that certain excreta are 
disposed of only with difficulty through the several 
vicarious agencies. Apart from the utilization of the 
intestinal tract, which does not concern us here, our 
main reliance is on the glandular- apparatus of the skin, 
whose activity is accelerated by external warmth, and 
almost in abeyance in a cold medium. We therefore 
appropriately employ warm clothing, hot-air and hot- 
water baths, besides promoting diaphoresis in every 
other way. Warm weather is the mildest and most con- 
tinuous diaphoretic known; its dosage can be gauged 
accurately by observing the thermometer and regulating 
exercise, and we can safely push this treatment to the 
verge of enervation; we must, however, take pains to 
avoid a high percentage of atmospheric humidity, as 
this in turn tends to check perspiration. 

Thus, in prescribing a warm and dry climate in the 
treatment of chronic nephritis, we meet the sparing 
indication exceptionally well; we may now pass on to 
details. In regard to the choice of a first-class winter 
climate for patients suffering from this disease, especially 
for such subjects as also, for any reason, require absten- 
tion from muscular exercise, most -of the authorities do 
not hesitate to recommend what Leonard Williams calls 
" relaxing" climates, meaning thereby such resorts as 
Madeira, southern Florida, and the Bermudas, which 



VISCERAL DISEASES 291 

are decidedly warm and rather moist during the winter 
months. Moisture is, however, always objectionable, 
and such less warm, but dry, regions as Egypt, southern 
Arizona, and the Mexican plateau are, in my opinion, 
decidedly preferable. The southwest of California also 
takes a deservedly high rank; Algiers, Malaga and Sicily 
are nearly as good. With regard to California, I would 
refer especially to a recent communication by Edwards, 1 
in which a modest claim for curing only cyclic and 
orthostatic albuminuria is made, but from which we are 
bound to conclude that cases of true chronic nephritis, 
following the infectious diseases, are at least brought to 
a standstill, with the total disappearance of albumen 
from the urine. The warmer portions of our South 
Atlantic States, as well as the Riviera, must be regarded 
as somewhat inferior ; both of these sections occasionally 
have very bad weather in winter, and are more suitable 
to the uncertain transitional period of early spring. 

Perier 2 does not hesitate at a general condemnation 
of the French coasts in the treatment of nephritis and 
albuminuria ; the material collected by the French ob- 
servers is sufficiently ample to justify any standpoint 
they may take on resorts so familiar to them; in any 
event, a careful climatic survey of France seems to limit 
the scope of its shores, in nephritis, to the thirty-mile 
strip on the Riviera, from Cannes to the Italian frontier. 
It therefore goes, almost without saying, that even. our 
pleasantest northern resorts, as well as the most favored 
stations of northwestern Europe, are not to be considered 
at all in treating such patients during the cold season. 

1 Archives of Pediatrics, June, 1905. 

2 Annales de medecine et de chirurgie infantiles, 1901, p. 479. 



292 THE CLIMATIC TREATMENT OF CHILDREN 

In the management of this group," it is also very im- 
portant not to permit too early a return home; as a 
valuable guide I would recommend the map, previously 
given, which shows the progress northward of settled 
spring weather. As the farther South grows too warm, 
an intermediate station may be chosen, to bridge over 
the period of transition; there are many excellent semi- 
southern inland stations on the southern slope of the 
Alps and in our southern Alleghanies. This precaution, 
reversed, is far less important in autumn in this coun- 
try, for reasons before stated; we can afford to wait 
until really cool weather sets in, and then transport the 
patient to the far South at once. 

In summer, the whole matter is very much simpler. 
The best results are obtained at fairly warm localities, 
avoiding intense heat and a humidity in excess of 75 
per cent. The best mean temperature is between 68 
and 72 degrees, depending largely on the age of the 
patient and his capacity for exercise. Speaking gener- 
ally, inland resorts are best, for the fogs and damp winds 
of all but the warmest seaside stations are objectionable. 
On the other hand, places not far from the coast, but 
free from the aforesaid disagreeable features, with the 
temperature still somewhat equalized by oceanic influ- 
ences, may safely be recommended. Southern New 
England and western Europe afford many such resorts, 
neither too cool nor too warm, with about the right pro- 
portion of humidity and a moderate rainfall. The very 
dry climates, such as that of the Southwest, may be 
quite as beneficial, but there the dustiness of the summer 
is an objectionable element. Most of the Californian 
resorts are either too hot or too cold and damp at this 



VISCERAL DISEASES 293 

season; in general the northeastern states will be found 
better from June to September or October. 

As to high altitudes, the consensus of opinion is ad- 
verse. Edel 1 goes into the subject at some length, and 
attributes the unfavorable results at great elevations to 
an increase of the blood pressure. It is true that the 
blood pressure is already excessively high in advanced 
cases of chronic nephritis, but this is a more serious 
matter in adults, who are apt to be suffering from a 
concomitant arteriosclerosis, and therefore dare not run 
the risk of a further strain on the arteries than in chil- 
dren, whose renal affection is likely to be comparatively 
recent. It is worth while to note that this same author 
makes a counter-recommendation, in that he deems the 
moderately high Alpine resorts well suited to the treat- 
ment of mere cyclic albuminuria. Now, we have seen 
that it is quite impracticable as well as inexpedient to 
draw a line between simple albuminuria and the more 
insidious forms of chronic nephritis; when, therefore, 
Edel says that the increase of arterial pressure at high 
altitudes actually benefits the former, he seems to place 
us in a sort of dilemma. The matter is, however, not so 
confused as appears at first thought, and quite suscepti- 
ble of explanation; the trouble lies, once more, in undue 
reference to children of the observations made on adults, 
often beyond the prime of life. Edel's standpoint is 
quite acceptable, if correctly interpreted; it is unques- 
tionably true that recent cases of nephritis, in which 
secondary fibrosis has not yet set in to any note- 
worthy extent, possibly also the early stages of the large 
white kidney, and naturally mere albuminuria without 
1 Munchener medizinische Wochenschrift, May 10, 1904. 



294 THE CLIMATIC TREATMENT OF CHILDREN 

demonstrable renal lesions, may do very well at moderate 
elevations. 

The wisest procedure consists in exercising a consider- 
able amount of conservatism in regard to sending chil- 
dren with Bright' s disease or albuminuria to mountain 
resorts; in any event, it is well to limit the altitude to 
3,000 feet, save where the patient's former residence 
has thoroughly habituated him to a low atmospheric 
pressure. Therefore, children native to the middle 
Rocky Mountain region, who give evidence of one of 
these affections, may frequently be permitted to remain 
at home during the summer months, the more so as the 
temperature and humidity conditions there are of the 
very best. In winter, however, it is undeniable that a 
milder climate is far more beneficial. 

With the exception just mentioned, the higher eleva- 
tions are, in almost every case, too cold for nephritic 
patients, and usually also too damp ; in the mountains 
of central Europe I should certainly set the limit at 
2,000 feet, save in carefully selected cases. The same 
limit may be applied quite generally in the northern 
Alleghanies; on the other hand, Edel's recommendation 
for the mild types ought to obtain the benefit of a trial 
in the higher southern Alleghanies; Asheville and Hot 
Springs, Va., are more than sufficiently warm, and I 
would not hesitate to make the suggested experiment in 
the presence of mere albuminuria. 

It is sufficient, in this connection, to repeat that the 
genuine contracting kidney is a curiosity in childhood, 
and that the secondary contracting kidney has rarely 
had time to develop; general arteriosclerosis is likewise 
very uncommon in early life, though cases have been 



VISCERAL DISEASES 295 

reported in connection with congenital syphilis. As a 
rule, the main objections to moderately high altitudes 
fall away, when we consider the young subject exclu- 
sively. 

The practitioner, as already stated, cannot exercise 
too much caution with regard to the abandonment of the 
very mild regions in favor of such as are more bracing, or 
the home climate. No change of consequence should be 
ventured upon until it is quite settled that the disease 
has reached a standstill; when that has been satisfac- 
torily ascertained, the cooler climates have a field of 
usefulness in the way of a renal test, to determine the 
probability of a more or less permanent cure or ameliora- 
tion, before the patient returns to his former life. The 
worst cases seem to demand permanent residence in a 
mild climate, unless we wish to invite an early relapse; 

It should hardly be necessary to add that, even when 
very mild maritime resorts have been selected, sea baths 
are contraindicated in renal and albuminuric cases. 
The ocean, in summer, rarely has a temperature much 
exceeding 75 degrees, even in subtropical latitudes, and 
in winter, at the warmest stations mentioned, it is usually 
very much colder. On the other hand, the indoor ad- 
ministration of sea-water baths at 92 to 95 degrees is 
of great benefit, for sea water,, containing four or five 
times the physiological (isotonic) proportion of salts, 
powerfully stimulates cutaneous osmosis, promoting the 
excretory functions of the skin in an effective, yet not 
excessive degree. 

The "Surgical" Kidney. The suppurative renal af- 
fections, so far as they do not fall within the scope of 
the operative surgeon, are quite certain to derive some 



296 THE CLIMATIC TREATMENT OF CHILDREN 

benefit from the somewhat relaxing treatment just 
recommended for nephritis and albuminuria. Chronic 
pyelitis and pyelonephritis are far more apt to run a 
favorable course in a decidedly warm climate than else- 
where, on the same principle of sparing the renal tissues 
as far as possible. Uncomplicated renal lithiasis is not, 
to any extent, a subject for climato therapy; but the 
combination of calculi and suppurative nephritis is quite 
frequent, at least clinically, and here we must follow the 
main indication, offered by the inflammatory process, 
so far as physical therapeutics are concerned. Even 
more than in ordinary nephritis is time an element in 
treatment, and the attendants of the child must be pre- 
pared for a stay in warmer latitudes, extending over the 
entire cool season, or it may be, a year or more, rapid 
cures being entirely beyond the realm of possibility. 

In many of these cases there is manifest advantage in 
combining treatment with one of the alkaline or earthy 
mineral waters with suitable measures of climatotherapy. 
Vichy in France, and Neuenahr and Wildungen in 
Germany, to select a few examples, are admirably 
adapted to this plan. It is doubtful if any American 
springs are equally good, at any rate there has* been no 
intelligent study made in this direction. Unfortunately, 
this combined treatment, at the European spas, is feasi- 
ble only during the warmer months, for these climates 
are all far too cold and moist from October to April; as 
a matter of fact, visitors are not. even expected at these 
resorts during the cold season. 

Hirsch 1 claims that the climatic theory of renal 
lithiasis, which is the commonest underlying cause of 
1 See bibliography. 



VISCERAL DISEASES 297 

suppurative disease of the renal pelvis, is not founded 
on fact; this affection is indeed exceedingly common in 
lower Egypt and in Italy. Notwithstanding, it remains 
true that practically all these cases do better in warm 
and dry climates than elsewhere, and that they are apt 
to fare rather poorly in marine or inclement localities. 
The indication of warmth is far less imperative in the 
cases of simple renal lithiasis than in those in which a 
suppurative process has supervened; in the latter it is 
the main point to be considered in treatment. 

The prudent practitioner will naturally be very re- 
served in giving a prognosis for these cases, especially 
with regard to the element of time. Nevertheless, al- 
though the prolonged course of these affections makes 
the benefit of climato therapy somewhat conjectural, we 
always seem to feel that these patients would not have 
got on so well at home. 

In contradistinction to the suppurative affections of 
the kidney, mere hydronephrosis rarely calls for climatic 
treatment. The advantage of a change of air, apart 
from its general beneficent influence, is very doubtful, 
and, in non-operative cases, the choice of residence is 
not very material. Operated cases, of course, recover 
strength more rapidly in a favorable climate, the same 
as other convalescents. 

Diseases of the Bladder. Climato therapy plays rather 
a minor role in vesical diseases, but removal to a milder 
climate will often be highly beneficial in cases of chronic 
cystitis. Some care is, however, advisable in adopting 
this plan of treatment, in view of the tendency to a 
higher concentration of the urine in warm weather, caused 
by the increased elimination of water through the skin. 



298 THE CLIMATIC TREATMENT OF CHILDREN 

When the urine attains a high specific gravity, it is apt 
to increase the vesical irritation, and thus neutralize 
some of the improvement to be expected in a mild 
climate. It is therefore wise to exercise some discretion, 
and avoid localities where the day temperature rises 
much above 70 degrees; in winter, merely temperate 
regions, such as California and the Riviera, as well as 
the South Atlantic States, are best in every way; in 
summer, we should select the moderately cool and moist 
inland resorts, avoiding the high and cold .mountain 
stations, as well as arid regions. 

The observations on mineral springs, made a few 
pages before, apply here with special force, for the 
alkaline waters are of the highest value in these affec- 
tions. It is a curious and inexplicable fact, that equally 
good results' are never obtained from the same waters 
when taken at a distance from their source, though they 
are of some value even then. 

The treatment of enuresis belongs, more appropriately, 
to the section on nervous diseases, but, apart from the 
undeniable neurotic element, vesical irritation is often 
an important factor, especially in such forms as are 
diurnal and associated with pollakiuria; the climatic 
indication here is similar to that of manifest cystitis. 
In the purely nocturnal type of enuresis the neurotic 
element undoubtedly predominates, but these cases may 
also be benefited by a similar course of treatment; this 
affection can, however, be discussed to better advantage 
under the heading of nervous irritability, of which it is 
a rather typical manifestation; anatomical lesions of the 
urinary tract are usually quite absent in purely noc- 
turnal enuresis. 



VISCERAL DISEASES 299 



DISEASES OF THE DIGESTIVE SYSTEM 

The interrelation between diseases of the alimentary 
tract and climatic conditions obtained full consideration 
in the first and fourth chapters, where the prophylactic 
value of climatotherapy in this group of affections was 
made evident. Owing to local causes, the study of this 
branch of our subject has centered largely in certain 
American cities; hot summers and sanitary neglect, 
either of which might have been tolerated by itself, in 
combination had become 'irresistibly fatal to infants and 
very young children, and the amelioration of hygienic 
deficiencies, by means of the inspection of milk and the 
improvement of the tenements, was taken in hand with 
some vigor. But, as previously noted, progress in this 
direction has certain well-defined limits, set by unfavor- 
able climatic and housing conditions which, of course, 
cannot be obviated ; within these limits the prophylactic 
measures just mentioned are attended with reasonably 
good results. When, however, gastro-intestinal disease 
has actually set in despite all precautions, removal to a 
better climate is our main resource. 

For our purposes, the topic of digestive disturbances 
centers on the presence of diarrhoea, and the best manner 
of proceeding with our subject is to divide it into the two 
sections of acute and chronic diarrhceal diseases. The 
anatomical picture, be it a mere indigestion, a bacterial 
intoxication, or an entero-colitis, is relatively unimpor- 
tant so far as climatotherapy is concerned, and chiefly 
affects the duration of treatment and the prognosis, the 
methods being the same for all. 



300 THE CLIMATIC TREATMENT OF CHILDREN 

Acute Diarrhoea! Diseases. Since a high atmospheric 
temperature and humidity are the prime factors in pro- 
ducing acute diarrhoeal disease, the obvious indication is 
removal to a locality that is cooler or drier, preferably 
both. In the case of the children of the well-to-do, this 
is a comparatively easy matter, and a few days at a cool 
seaside or mountain resort will almost invariably work 
wonders. The distance traveled need not always be 
great, and with badly exhausted children, who do not 
bear railway transportation well, this is a matter of some 
little consequence. Even in the suburbs of cities, the 
night temperature is three to four degrees lower in sum- 
mer, and in the actual country districts there is a differ- 
ence of seven degrees and more at night in clear weather, 
though the day temperature may not be any lower. 
Thus the daily range in New York City, in July and 
August, is between 66 and 81 degrees, whereas among 
the low hills of Westchester County it ranges from 59 
to 81. At the seashore the nights are not so much cooler 
than in town, but the sea breeze cuts down the afternoon 
temperature, so that the south coast of Long Island has a 
daily range from 64 to 76 degrees. In the former region 
the humidity is a little lower than in the city, in the 
latter a little higher; the chief gain is in a lower tempera- 
ture and purer air. It is, of course, better, whenever, 
practicable, to remove the infant to such cool and bracing 
climates as the northeastern coast or mountains, or the 
cooler stations in the Lake Region; in the presence of a 
severe attack, however, a long journey may be inadvis- 
able, and in the case of the large cities near the seaboard 
and lakes, it is not generally necessary. 

The children of the poor cannot, for pecuniary reasons, 



VISCERAL DISEASES 301 

be transported to distant resorts, and must avail them- 
selves of the best near-by situations. In our seaboard 
towns the problem is relatively simple, and children may 
be conveyed to the breeze-swept ocean front, a thousand 
or more at a time, in boats or barges, the trip itself being 
something of a remedial measure. Transportation by 
rail, on the other hand, is rather injurious, and should 
be avoided whenever a journey by water is feasible. 

A very easy, but unfortunately rather ineffectual, plan 
of treatment is by means of the day trip in the so-called 
floating hospitals. These institutions, in the form of 
great barges, under the supervision of a competent- 
physician who is aided by a staff of nurses, leave the city 
in the early morning, call at convenient landing places, 
cruise about the quiet waters of the harbor, and return 
toward sunset. Great as is the relief afforded by the 
floating hospitals, it is but palliative, owing to the 
necessity of returning the sick infant to the fetid 
tenement for the night; it is doubtful if the trip perma- 
nently benefits any but the mildest cases and older chil- 
dren, and there is every reason to believe that the chief 
value of the floating hospital is in the good food, medical 
attendance, and educational influence afforded on board. 

The imperfections of the floating hospital may be 
largely remedied by operating it in connection with a 
seaside sanatorium. All the serious gastro-intestinal 
cases should be referred from the former to the latter; 
the floating hospital thus forms a' capital channel for the 
selection of patients for the sanatorium, which alone can 
effect a real cure in all but the milder dyspeptic cases. 
Our seaside sanatoria are all deficient in allowing the 
little patients too short a stay, two weeks being usually 



302 THE CLIMATIC TREATMENT OF CHILDREN 

the limit; it must be admitted, in extenuation, that these 
institutions are not entirely free agents, owing to popular 
ignorance and insufficient accommodations. We are 
evidently still in a stage of early development in regard 
to these matters, and more education is needed by both 
the philanthropist and his beneficiaries. 

In- inland cities, such as Cincinnati or St. Louis, the 
problem of caring for the children of the poor, during the 
intensely hot summer that prevails in those latitudes, 
presents the gravest difficulties. The seashore or lake 
front is hundreds of miles away, and the level character 
of the surrounding country renders a reasonably cool 
refuge in the vicinity absolutely unobtainable. In the 
unusually hot July of 1901, for example, not a single 
locality in the state of Missouri was as cool as the low- 
lands of Porto Rico and Cuba, and the other central 
states were but little better. At the same time the 
average temperature on the eastern Maine. coast, in the 
higher northern Alleghanies, and in northern Michigan, 
ranged from 62 to 68 degrees, though that month was one 
of the hottest on record in these localities also. These 
cool regions are inaccessible to the children in the cities 
mentioned, except in the case of very well-to-do families, 
who rarely spend the summer in town in any event. 

The credit for developing and studying the subject of 
floating hospitals and seaside sanatoria belongs, in the 
first instance, entirely to private philanthropy in Boston, 
whence these institutions have spread to New York and 
Chicago, but to few other localities. The municipalities, 
with all their wealth and resources, have done little or 
nothing, as is usual in this country. When we analyze 
the subject carefully, we see that even such private 



VISCERAL DISEASES 303 

activity as has been manifested in this direction is al- 
most entirely due to the fact that the cities mentioned 
have been relatively favored by nature, as their situation 
on the water front affords unusually good opportunities 
for communal work of the kind described. This remiss- 
ness of the municipalities, to which there are hardly any 
exceptions — New York is only to-day awakening 1 to the 
situation, now that nearly all of her magnificent water 
front has been occupied for other purposes — should not 
astonish anybody who is familiar with our municipal 
administrations and their ways. It is true that we have 
done better than the Europeans in a few details, but our 
climate renders our necessities infinitely greater. 

Chronic Diarrhceal Diseases. Next to the immediate 
peril to life, the chief danger involved in the acute 
diarrhceal diseases of infants and young children is the 
eventual development of a chronic enter o-colitis. This 
is peculiarly apt to. follow an acute intestinal inflamma- 
tion, but is also a frequent result of a neglected or in- 
adequately treated indigestion. It appears more than 
probable that the treatment of acute diarrhceal affections 
by a mere day's outing is often responsible for this un- 
toward outcome. The baby shows some improvement 
after its trip, but is not quite well; the same treatment 
is repeated for days with only partial success; the infant 
in the mean time sleeping in a stuffy tenement and 
possibly being improperly fed besides. It is evident 
that a case of this sort would have fared better under 
sanatorium treatment in the first instance, prolonged 
until an actual cure had been effected, and maintained 
for some days thereafter. 

1 Boston awoke a few years ago. 



304 THE CLIMATIC TREATMENT OF CHILDREN 

For chronic diarrhoea in children, as it occurs during 
the • summer months, a change to a cooler climate is 
absolutely imperative, and we may say at once, the 
cooler the better, barring such as are absolutely raw, for 
example, exposed situations from San Francisco north- 
ward; on the Atlantic coast there is almost no place 
that is too cool for these cases, and Maine and Nova 
Scotia are probably best of all. In a line with these 
might be set the higher elevations from the Catskill 
Mountains northeastward, the hill country from Penn- 
sylvania southward being hardly cool enough for the 
best results, as the day temperatures are apt to be rather 
high. Long Island and New Jersey are likewise a little 
too warm and sultry to achieve the best results in chronic 
diarrhceal disease; the cooler portions of the Lake Re- 
gion, as for instance northern Michigan, are decidedly 
better, but still not so bracing as our northeast coast. 
The shores of northern and western Europe offer many 
excellent situations, but the ocean voyage is an impedi- 
ment to be regarded seriously in digestive disorders; in 
selected cases, especially in older- children, the resorts 
along the English Channel, North Sea, and Baltic may 
be tried, and the mountains of central Europe offer no 
end of highly salubrious stations, with the additional 
important consideration of better food than is dealt out 
by the average American hotel proprietor. It must not 
be forgotten, in this connection, that cases of chronic 
diarrhoea no longer tolerate the semi-starvation that is 
often a valuable curative agent in acute indigestion. 
On the contrary, the food must be rather ample, and, 
furthermore, of a kind and preparation to spare the 
diseased intestine as much as possible. Persons familiar 



VISCERAL DISEASES 305 

with the dietary at many American summer hotels, even 
some of the higher-priced grade, will appreciate the force 
of these remarks, and the difficulties likely to be en- 
countered. 

For the children of the poor, climatic treatment is even 
more essential, but the question of expense is, at least 
in this country, an obstacle to the selection of a truly 
first-class climate, so far as most cities are concerned; 
it usually becomes necessary to choose the best near-by 
locality for a children's sanatorium. While it is incon- 
testable that some very fair work has been done in this 
field, the greater part still awaits realization ; at present 
the sojourn of the patients in the mountains or at the 
seaside is generally limited to a few weeks, a period 
altogether too short to effect a cure in a large proportion 
of cases, the more so as the children are sent back to the 
noisome atmosphere of the city before the hot season 
is over. Better provision should be made for keeping 
obstinate diarrhceal cases, especially such as show a 
general impairment of health, in the country at least 
until the end of August in the North and some weeks 
later in the South. This can, unfortunately, be effected 
only after an increase of the present facilities, which 
suffice only for the more urgently sick children. We 
must, moreover, not forget that a little more education 
of the public is also demanded; too many parents are 
apt to desire the return home of their children, long 
before anything like a complete cure has been effected. 

Children above the age of three or four years are not 
benefited so much as infants by a stay at our moderately 
warm seaside resorts, and an earnest endeavor should be 
made to send them to a truly bracing summer climate, 



306 THE CLIMATIC TREATMENT OF CHILDREN 

preferably aksome little elevation. The older the child, 
the more persistent a type of intestinal catarrh is apt 
to be before us, since a more serious, long-continued, or 
often repeated acute disturbance was necessary to set up 
a chronic condition. We cannot, therefore, go far astray 
in choosing a more energetic form of climato therapy in 
older children, and insisting on its prolonged continu- 
ance, preferably until cool weather has come to town for 
the season, even if the patients appear thoroughly well 
weeks before that time. All our eastern highlands are 
suitable to these cases; the far northeastern coast resorts 
are' not quite so good, being too damp, and sometimes 
rather raw, but they often prove quite adequate. For 
children *of the school age, the July isothermal of 66 
degrees represents the southern limit, which it is best 
not to overstep, if we desire to achieve really brilliant 
results. The Rocky Mountain resorts are rather warmer, 
but the extreme dryness acts as a compensatory factor, 
so that a few extra degrees of warmth may be disregarded. 
In central Europe, nearly all the popular resorts suit 
our purpose, as is also true of the Atlantic coast from 
France northward and eastward to the Baltic Sea. 

It is useful and important to remember that a pro- 
longed stay, beyond what is actually necessary to achieve 
an apparent cure, will in no case be superfluous; as 
observed before, children of the school age are in any 
event a troublesome proposition under our modern con- 
ditions, and a little surplus of vitality can only be 
advantageous in the long run. 

Non-diarrhceal Dyspepsia. Digestive disorders that 
are not attended with diarrhoea do not usually call for 
climatic treatment. An exception should, however, be 



VISCERAL DISEASES 307 

made in all cases of infantile dyspepsia, even if diarrhoea 
be absent; though this statement seems almost unnec- 
essary, its important therapeutic suggestion is often 
disregarded, with disastrous results. The practitioner 
who sends all infants and yoimg children that manifest 
any sort of severe digestive disturbance during the 
warm season to a cool resort in the country will have 
the smallest proportion of debilitated subjects on his 
hands in the autumn. It is a grave error to await the 
appearance of diarrhoea, before resorting to a change of 
climate; its success is so certain,' its omission so fraught 
with danger, that the only safe procedure is to prescribe 
it promptly in every case, losing no time with temporiz- 
ing or mere internal medication. Material considera- 
tions should not be allowed to stand in the way of the 
one sovereign remedy, and fortunately it is usually 
available in some of our cities for rich and poor alike, 
although perhaps inadequately so far as the latter are 
concerned. 



RESPIRATORY DISEASES 

We have already remarked that the diseases of the 
respiratory system, so far as seasonal distribution goes, 
present a sort of complement to the affections of the 
digestive tract; the association of climate and disease is, 
however, far less intimate in the group here under 
discussion. Another difference lies in the circumstance 
that acute respiratory diseases are not in any way sub- 
jects for climatotherapy, but require home treatment 
alone. The question of "catching cold," so interesting 
in this connection, has obtained ample consideration in 



308 THE CLIMATIC TREATMENT OF CHILDREN 

a previous chapter, and does not call for further mention; 
in the same place the prophylactic aspects of the subject 
received full attention, and repetition here would be 
superfluous; the few points not touched upon adequately 
will be developed as we go on to describe therapeutic 
details. 

' Chronic Bronchitis. Chronic bronchitis is not an 
uncommon affection even in very young children, if we 
include recurrent bronchitis, which belongs here clinic- 
ally and for purpos.es of treatment. On the other hand, 
cases in which this affection merely complicates a tu- 
berculous process are to be excluded from considera- 
tion here; they are best disposed of in connection with 
the underlying disease. If we adopt the classification 
just mentioned, we find that we are dealing with a tol- 
erably well-defined group. 

We sometimes encounter chronic bronchitis as a 
primary affection, in hearty, well-nourished children 
whose apparent robustness is indeed somewhat magnified 
by the exaggerated development of the thorax that 
results from the frequent and violent cough and occa- 
sional dyspnoea. Chronic pulmonary emphysema^ of 
the type so commonly associated with the chronic 
bronchitis of advanced fife, is rare, if not unknown, in 
childhood; at this age emphysema is an acute and 
transitory affair, differing widely in its histology from 
the lesion of that name in elderly subjects. 

Most of the children, however, that come to us with 
chronic bronchitis, suffer from rickets or its sequelae, 
such as a thoracic deformity (pigeon-breast) or a spinal 
curvature. Next in order come those who present 
some form of lymphatism, be it a true scrofulosis, or a 



VISCERAL DISEASES 309 

glandular hypertrophy in the faucial ring. Not especially 
rare are the cases associated with congenital syphilis; 
here the immediate cause usually consists of gummatous 
deposits, with lymphatic infiltration,, about the larger 
bronchi'; such patients usually do well enough under 
specific medication, but the cure is likely to be acceler- 
ated by removal to a good climate. Many of the worst 
cases are unquestionably the product of experiments 
in hardening that have miscarried, especially when ir- 
rational persistence in the regime of strenuousness has 
established a vicious circle, as not infrequently happens. 
These last embody the most telling reply to the relentless 
advocates of cold plunges and the like for young chil- 
dren, and are a standing reproach to the blind devotees 
of routine treatment for young and old alike. 

In entering upon a detailed review and* classification 
of chronic bronchitis, we may begin by distinguishing 
three types. First, we have the recurrent -cases that 
suffer from repeated attacks, with more or less brief 
intermissions, most persistent and severe in the cold 
months, but sometimes tending to run on into the spring, 
the summer being relatively free. Secondly, we note the 
asthmatic cases, presenting similar seasonal variations, 
but with less tendency to complete remission while 
cold weather lasts, and attended with the symptom 
group known as bronchial asthma. Thirdly, there are 
the cases characterized by free secretion, with or without 
the development of bronchiectatic cavities, but without 
any tangible evidence of tuberculosis; this last type is 
peculiarly apt to follow an attack of measles or pertussis. 
It goes without saying that many children do not fit 
exactly into any one of these groups, and the first and 



310 THE CLIMATIC TREATMENT OF CHILDREN 

second are apt to run into one another; a case of simple 
recurrent bronchitis may gradually become asthmatic, 
and, on the other hand, the sufferer from severe asth- 
matic attacks may improve so far as to present merely 
a recurrent cough with abundant rhonchi and tenacious 
secretion. 

The treatment of these cases with a change of climate 
is anything but simple. Rickets and scrofulosis, includ- 
ing the various phases of lymphatism, are to be managed 
according to principles laid down elsewhere in this work, 
but, aside from these complications or underlying dis- 
orders, it is not easy to lay down any general rules. So 
much is clear, that in any event a moderately warm 
climate, not likely to entail enervation, is to be chosen, 
so that the child can pass the greater part of the day in 
the open air, without excessive exposure to cold winds. 
When we come to the choice between inland and seaside 
resorts, we find that the authorities differ amazingly; 
thus, Hoffmann 1 and Keller 2 favor the mild marine cli- 
mates, whereas Weber and Foster 3 prefer elevated' inland 
sites. The balance of opinion, however, inclines to the 
former, and we must remember, once more, that the 
seaside is not necessarily damp in winter, but, on the 
contrary, has a tendency to be drier than the hinterland 
in southerly latitudes. Rode's 4 claim of good results at 
Norderney, even in the cold months, stands almost alone; 
the raw and damp winter climate on the North Sea coast, 
with an average temperature little above the freezing 
point, is the very one we would look on with disfavor 

1 Op. cit. 

2 Monatsschrift flir Kinderheilkunde, Oct. 1903. 
• 1 See bibliography. 

4 Berliner klin. Wochenschrift, April 13, 1896, 



• VISCERAL DISEASES 311 

in treating chronic bronchitis; Perier 1 distinctly rejects 
the far milder coast stations of France, even those of the 
southeast (Cette), with a doubtful exception in favor of 
the Riviera. 

California and the warmer Mediterranean resorts are 
therefore quite suitable, and the South Atlantic coast 
ranks just a little lower. Our Middle Atlantic coast 
must be employed with some discrimination, as the 
temperature is a little too low, though there is a high 
proportion of sunny days; in view of the high and fre- 
quent northwest winds this sect-ion is best reserved for 
the purpose of bridging over the treacherous period of 
early spring, or for an after-cure. The same may be 
said even of the milder stations of western Europe, as 
the English Channel resorts. 

I see little occasion for dilating on the treatment of 
these cases in the mountains, during the winter and 
early spring, for the weather is quite certain to be too 
cold and windy. An exception may be made in the case 
of the southern Alleghanies and the southern slope of 
the Alps, as well as the Pyrenees, in early spring, before 
the final return north. We shall always do well to 
adhere to the rule of extending the course of treatment 
over the entire cold season, that is, until the temperature 
at home begins to average from 50 to 55 degrees. 

After the above general review, we may glance at a 
few exceptions. First, as to the asthmatic cases, we 
are in a sort of quandary; Avellis, 2 for example, says 
that only children are likely to* improve at the seashore, 
admitting, at the same time, that no climate guarantees 

1 Loc. cit. 

2 Miinchener med. Wochenschrift, Nov. 15, .1904. 



312 THE CLIMATIC TREATMENT OF CHILDREN 

relief; Osier 1 praises California and Florida; Holt 1 
prefers a drier climate than the latter, with some eleva- 
tion; Henoch 1 thinks that an inland resort should be 
selected to inaugurate treatment in any event, and 
reserves the seaside for an after-cure, as being of uncer- 
tain value. On only one point do the authorities agree, 
namely, that high elevations are objectionable; other- 
wise the differences of opinion are so great as to impress 
us chiefly with the empirical status of the whole matter. 
It is evident that the climatic treatment of asthma is 
unsatisfactory, though perhaps not quite to the degree 
experienced in adults. 

We may now turn to those cases of bronchitis, a fairly 
large proportion of the total, that are characterized by 
abundant and not very viscid secretion, with or without 
demonstrable bronchiectases. Here we find little divers- 
ity of opinion ; it seems to be quite generally agreed that 
these patients do best in a dry climate ; in this connection, 
however, it is of interest to note the very scant reference 
to the very arid desert regions, an omission readily 
accounted for. It is indeed plain that extreme drought, 
with its inevitable fine dust, is one of the worst possible, 
irritants to the inflamed bronchial mucosa, and the wise 
physician will precede the ultimate disposal of this class 
of cases with a glance at the tables of relative humidity as 
well as the temperature, choosing a climate having 65 to 
75 per cent, of moisture, with a reasonable amount of rain 
to obviate dustiness. This last annoyance is mitigated 
to a great extent on the eastern slope of the Rocky 
Mountains, where afternoon showers are not uncom- 
mon in spring and early summer; between showers the 
1 See bibliography. 



VISCERAL DISEASES . 313 

atmosphere there is quite dry. The summer months 
are very much too arid in California, away from the 
coast, and the dust forms a fearful plague. At best, 
the western half of the continent, with very few ex- 
ceptions, while unsuited to the treatment of asthmatic 
cases, is more likely to benefit cases with excessive secre- 
tion and bronchiectases; selected patients of the latter 
group may be referred to such regions as the eastern 
slope, with some prospect of affording relief. 

Apart from the cases with free secretion, just disposed 
of, there is little of real importance to be said concerning 
a suitable summer climate. The simple and recurrent 
cases improve in summer in any event ; we shall do well, 
however, to avoid high elevations, very low tempera- 
tures, high winds and sea fogs. The asthmatic cases 
present so uncertain a proposition that we are driven to 
resort to individual experimentation whenever the mere 
arrival of summer does not occasion improvement. 

In closing the discussion of the treatment of chronic 
bronchitis, we may emphasize the importance of treat- 
ing any discoverable underlying affection; it .is a curious 
fact that the primary cases afford the more vexatious 
difficulties in therapy, and medicinal treatment is even 
less satisfactory than climatic management, so far as 
cure or permanent amelioration is concerned. 

Chronic Affections of the Upper Air Passages. Apart 
from such cases as merely complicate lymphatism, the 
principles stated in the paragraphs on chronic bronchitis 
apply here also in a general way; our guide is once more 
the amount of secretion, according as we are confronted 
with a hypertrophic or an atrophic catarrh. Solly 1 goes 

1 Journ. of the Amer. Med. Association, Nov. 14, 1903. 



314 THE CLIMATIC TREATMENT OF CHILDREN 

into the merits and deficiencies of the climate of Colorado, 
for the treatment of this group, in fairly minute detail. 
He observes that nasal obstruction usually becomes ag- 
gravated, and that respiration becomes more impeded; 
operative measures that were regarded as optional in the 
east, become imperative in the Rocky Mountain region. 
Atrophic rhinitis and ozsena also grow worse, the dryness 
and dust being extremely deleterious; moist hyper- 
trophic rhinitis, on the other hand, regularly undergoes 
improvement in this climate. It is just as well, however, 
to remember that the transformation of hypertrophic 
rhinitis into the atrophic form is apt to be favored by 
excessive dryness; we shall therefore not go far astray 
in regarding Solly's opinion on the hypertrophic group 
as somewhat optimistic. The abatement of a nasal 
blennorrhoea does not necessarily denote real progress, 
and its transformation into an atrophic condition, possi- 
bly with ozsena, is of doubtful advantage to the patient. 
In any event, it is usually advisable not to encourage 
too long a stay in the semi-arid regions, unless we are 
pretty thoroughly convinced that there has been real 
improvement; as a general thing, better results will be 
achieved at the moderately moist resorts even in mark- 
edly hypertrophic cases with a good deal of secretion. 
The atrophic cases unquestionably do best at the sea- 
shore, and even the most typically oceanic climate is 
hardly too damp for them. 

All forms of nasal catarrh are influenced unfavorably 
by cold and dry winds of the mistral type; it is indeed 
probable that they are largely responsible for the exces- 
sive prevalence of these affections on our continent. 
Warm and moist air is quite certain to be beneficial; a 



VISCERAL DISEASES 315 

really high temperature is, however, not needed, an 
average range of ten degrees or so above the freezing 
point being quite sufficient; the semi-southern coast 
climates will therefore be found quite satisfactory during 
the cold season. 

I have repeatedly found that persons who suffered a 
good deal from nasal catarrh in the dry and dusty cli- 
mate of the Great Plains, experienced marked relief 
when residing in New York, except in the rather dry and 
very windy period from December to March. During 
the warm and damp New York summer we hear but 
few complaints from these patients; all forms appear 
to undergo a relative improvement during that time. 

The lymphatic hypertrophies in the naso-pharyngeal 
region are often intimately connected with local lesions 
of the mucous membranes, though at times merely part 
of a general lymphatism; the rules for their climatic 
treatment follow those just indicated for the underlying 
catarrh. The very moist climates are not especially 
good in these cases; they are too relaxing, even if they 
would not add to the difficulties of normal nasal respira- 
tion. Far worse, however, are the cold and dry climates; 
here we regularly observe an increase in the tendency 
to mouth breathing, which becomes especially conspicu- 
ous on entering a warm apartment after exposure to a 
brisk northwester. It is easy to understand the harm- 
fulness of mouth breathing in cold weather; the alterna- 
tion of high and low temperature seems* to add to the 
mischief, and the effect of the overheated and dry air of 
most dwellings undoubtedly is worst of all. 

Pneumonia and Pleurisy. The pneumonia cases that 
concern us here are those with delayed resolution, for 



316 THE CLIMATIC TREATMENT OF CHILDREN 

which Holt well says that change of air is more important 
than all other forms of treatment combined. In winter 
and early spring, the usual seasons in which we encounter 
this condition, the removal should be to a decidedly 
warm climate, especially in the case of an infant, for 
whom the more southerly Florida stations are none too 
warm. Only after all the physical signs of consolida- 
tion have disappeared, may transfer to a more bracing 
climate be attempted, and in any case the return north 
is best postponed until the middle of spring. During 
the warmer months an unresolved pneumonia does not 
require removal to a very different climate, but even 
then the change to a sheltered inland locality is advan- 
tageous. The seashore is not particularly good for 
these cases, and the higher mountain resorts are apt. to 
be too cold; the situation often calls for the exercise of 
considerable judgment, but the physician will not go 
far astray by recommending a climate such as that of 
interior New York and New England during the warmest 
months, and New Jersey in the early autumn. 

A point to be remembered in this connection is that 
•the patient is usually not in condition to withstand a 
long journey," and it is therefore advisable to select the 
nearest locality that is likely to prove beneficial, in pref- 
erence to a slightly better, but more remote resort, 

Chronic interstitial pneumonia, with or without 
bronchiectases, is to be managed according to the indi- 
vidual case; the more robust subjects may be treated 
like those of simple bronchiectasis, the more feeble ones 
demand the greater care appropriate to unresolved pneu- 
monia; here, too, there is plenty of opportunity for wise 
discrimination. 



VISCERAL DISEASES 317 

Under the head of pleurisy we are mainly concerned 
with the treatment of the later stages of empyema. 
Suppuration is apt to continue for months after surgical 
intervention, and the danger of a general deterioration 
of the patient's condition is an important item. The 
best climate to begin with is the one we would select for 
an unresolved pneumonia; if the child's general health 
is fairly good, a slightly cooler region may be even more 
beneficial. The greatest importance attaches to the 
post-suppurative stage, when pleuritic adhesions inter- 
fere more or less with the expansion of the lung. Here a 
stimulating regime is called for, the child should spend 
the following summer at one of the cooler seaside resorts 
or at some elevation inland, for at this period enervation 
is the chief danger. The best places of all are probably 
the Alpine resorts, even the colder ones at elevations 
exceeding 3,000 feet; next come the higher stations. 
of New England and New York; Colorado is perhaps a 
little too warm during the day, but otherwise ranks 
high, owing to the large proportion of sunshine. Of 
seaside resorts those of western Europe and our extreme 
northeast rank about equally high; as we go south from 
the English Channel or Maine the climate becomes pro- 
gressively more relaxing and less suitable to these cases. 
On the Pacific Coast only certain spots, such as the 
sheltered portions of San Francisco Bay (e.g., San 
Rafael), interior Oregon, and Puget Sound, are neither 
too warm nor too raw. 

The other forms of pleurisy calling for climatotherapy 
are mostly associated with tuberculosis, and occur in 
older children, whereas metapneumonic empyema is 
peculiar to infancy and early childhood. For the man- 



318 THE CLIMATIC TREATMENT OF CHILDREN 

agement of the former the reader is referred to the 
paragraphs devoted to tuberculosis. 

A few words may be added on the sanatorium treat- 
ment of chronic respiratory diseases in children. It is 
notorious that these cases do not do well in the ordinary 
hospital aiid are apt to fall an eventual prey to grave 
anaemia or tuberculosis. Much of this, however, is due 
to errors in hospital management and is not true to the 
same degree of the most modern institutions. The weak 
spot of the general hospital is its lack of accommodation 
for convalescents, to which group these children most 
emphatically belong. Winter sanatoria are unf&rtu- 
nately still a novelty in this country, whereas Europe has 
been most plentifully supplied with them for decades. 
Only institutions of this type are adapted to the success- 
ful handling of this class of patients, for empyema and 
unresolved pneumonia, though occurring in well-to-do 
families, are pre-eminently diseases affecting the ill- 
nourished children of the poor. 

In one respect the foundation of a sanatorium for this 
class of cases presents some difficulty. A mild climate 
is quite essential, but is not obtainable within many 
hundreds of miles of our northern cities; to start such 
an institution in the South involves possibly legal ob- 
stacles, and certainly an expense for transportation that 
would prove burdensome; the difficulties of adequate 
supervision must also be considered. It is evident that 
the matter is far simpler in such countries as England 
and France, where a really mild winter climate is at the 
most five hundred miles away from, but generally much 
nearer to the great centers of population. The problem 
afforded by this* situation is assuredly worthy of serious 



VISCERAL DISEASES 319 

consideration by the medical profession and the chari- 
tably disposed public; the amount of physical impair- 
ment, associated with the far from negligible increase 
in the death-rate of young children, that is inseparable 
from our present methods, urgently calls for a remedy, 
to which foreigners have already shown us the way. 

Pertussis. The climatic treatment of pertussis has 
hitherto been somewhat neglected; a strange circum- 
stance, in view of the fact that it is almost the only one 
that really amounts to anything. The subject may be 
attacked from two points : first, as to the influence of a 
change of climate on the disease itself; secondly, as a 
prophylactic measure against the complications which 
form the chief danger of this otherwise not very serious 
affection. We shall begin with the former indication. 

Every practitioner has observed the benefit that chil- 
dren with whooping cough derive from a stay out of 
doors. The attacks are always fewer and milder in pure 
air than in the more or less vitiated atmosphere of the 
house, and the patient should be at home during the day 
as little- as possible. This presupposes suitable weather, 
is easily carried out in summer, but becomes a most 
difficult matter in the northern winter, especially where 
infants are concerned. During the first year of life, 
removal to a mild winter climate, where there is plenty 
of bright weather, is almost imperative, whereas older 
children, especially after the second year, may stay 
North in a fairly sunny region such as the Middle Atlantic 
Coast, where outdoor exercise is possible on a good many 
days, save in unusually cold or stormy seasons. In the 
Lake Region and the extreme Northeast or Northwest 
this is not often possible, and a change of climate is best 



320 THE CLIMATIC TREATMENT OF CHILDREN 

for older children also; this need not be radical, and 
New Jersey, for example, is almost always sufficiently 
mild and pleasant. 

It may be added that cases occurring during the sum- 
mer, south of Mason and Dixon's Line, do better farther 
north than at home, because they are less apt to be de- 
prived of the outdoor air by intensely hot days, which 
often necessitate staying indoors during the brightest 
weather and best hours. 

The second indication refers chiefly to the danger 
of pneumonic complications, especially in winter and 
spring; as to simple bronchitis, prophylaxis is quite in- 
effectual, and few young children escape. In summer 
these children, especially in the cities, are peculiarly 
liable to diarrhceal diseases, fostered by. a state of mal- 
nutrition in consequence of the frequent vomiting of 
food and the exhausting paroxysms. Both these con- 
siderations are extremely important during infancy, but 
become less serious with advancing age. 

It is a good rule to treat babies suffering from whoop- 
ing cough exactly like cases of chronic bronchitis or un- 
resolved pneumonia, according to the general state of 
health. The climate selected should be decidedly mild 
in the case of infants, for older children it may be more 
bracing. In summer the best plan is the one outlined 
as a prophylactic against gastro- intestinal disorders; 
here again, however, we must take infants to moder- 
ately warm resorts, for they run a considerable risk of 
pneumonia even in summer, when sudden variations 
of temperature take place. 

Do patients with pertussis get on better at the sea- 
shore or inland? American observers, as Holt and 



VISCERAL DISEASES 321 

Powell, 1 incline to recommending the former; Szego 2 
is in doubt, and thinks that pure air inland, may be of 
equal value; Fischl 3 is convinced that the paroxysms are 
mitigated in the moderately warm mountain resorts, 
but that the terminal stage is cut short at either the sea- 
side or among the hills. From the above divergence of 
opinion, I have come to the belief that the essential 
point is freedom of the atmosphere from irritating mat- 
ter, chiefly smoke and dust; this position is substan- 
tiated by the familiar observation that the paroxysms, 
that in town persist for many months after the disease 
has run its course, and which physicians as well as lay- 
men are apt to misinterpret as persistence or recurrence 
of the whooping cough itself, usually cease promptly 
when the patient is removed to either the mountains or 
the, seashore. Pertussis seems to be regularly followed 
by increased irritability of the epiglottic mucous mem- 
brane, and the avoidance of smoke and dust seems al- 
most indispensable as an after-cure; thus, any good 
country resort may meet the indication. 

No climate seems effective in cutting short the disease 
itself; the most we can do is to moderate the intensity 
of the paroxysms according to the method just stated. 
The efficacy of the saline sea breeze is mythical; the 
balsamic air of pine woods is a mere tradition, coniferous 
forests are simply freer from dust than deciduous woods. 
The infinitesimal traces of resin in the "piny air" 
cannot possibly have therapeutic value comparable, for 
example, to the inhalation of cresol vapor, which seems 

1 See bibliography. 

2 Archiv fiir Kinderheilkimde, 1899, vol. 27. 

? Berliner klin, Wochenschrift, May 21, 1906. 



322 THE CLIMATIC TREATMENT OF CHILDREN 

to be of some little use. It is time that the medical pro- 
fession ceased to imbibe its ideas on therapeutic matters 
from hotel circulars and railway folders. 

The main obstacle to the climatic .treatment of per- 
tussis is the difficulty of finding a locality where other 
children will not be infected by our patients. Fortu- 
nately, this disease occurs in such peculiarly sweeping 
epidemics that the proprietor of a suitable resort will 
occasionally find profit in catering to this class of patrons 
exclusively. 

Hay-fever. Hay-fever is not excessively rare in older 
children; Wyman 1 claims that fifteen per cent, of all the 
victims of this affection have their first attack by the 
tenth year. We have already referred to the recent 
discovery of a specific therapy, but this, while undoubt- 
edly correct in principle, does not give permanent relief, 
and has scored a considerable percentage of failures. 
It is therefore simpler, and preferable for other reasons 
also, to take the affected children to the immune summer 
and autumn resorts, whenever circumstances will permit. 
The. choice of locality must be in accordance with 
the data given in the first chapters; the results are then 
striking, relief being afforded almost instantaneously; 
moreover, these immune climates are otherwise ideal 
for most children, notably those of the age here under 
consideration. 

If it is desired to avoid the onset of this affection 
entirely, the patient must leave his home before the 
pollination of the ragweed begins. This happens about 
the middle of August in the latitude of New York, and 
Boston. The map at the end of the first chapter gives 
1 Autumnal Catarrh, 1885. 



VISCERAL DISEASES 323 

the immune regions in a rough way, by indicating the 
July isothermal of 66 degrees at the lower levels; relief 
may, however, often be obtained in more southerly 
latitudes in the Alleghanies by ascending the mountains. 
The altitude, approximate of course, of the immune line 
in the eastern highlands is as follows : 

St. Lawrence Valley, near Montreal : 800 to 1000 feet. 

White and Green Mountains, Adirondacks 1200 to 1400 ' 

Berkshire Hills and Catskill Mountains 1800 to 2200 " 

Pennsylvania 2400 to 3000 " 

Virginia and Wes^ Virginia 3000 to 3600 " 

North Carolina 4000 to 4400 " 

South of New York there are very few well-equipped 
resorts above the stated elevations. In Pennsylvania 
only a few ridges are sufficiently high; farther south the 
altitudes named are uninhabited or nearly so, and con- 
ditions unspeakably primitive. Only the northeastern 
hill country is therefore worth considering at all. 

The return home should not take place before the 
frosts arrive; the dates for the first killing frost are 
nearly the same for Boston, New York, and Washington, 
falling with almost imf ailing regularity in the first half 
of October, rarely earlier or later. 

DISEASES OF THE EAR 

The literature on the climatic treatment of aural 
diseases is rather uneven, very complete and accurate 
in some points, but almost ignoring others of no less 
interest; the following outline is therefore somewhat 
sketchy. Otorrhcea seems to do well at the seashore, 
especially in summer; even sea bathing, which we should 
naturally view with suspicion, appears to be distinctly 
beneficial; some discrimination, however, is called for, 



324 THE CLIMATIC TREATMENT OF CHILDREN 

Koerner 1 did not note any relapses of otorrhoea follow- 
ing sea baths, but Danziger 2 advises caution when a per- 
foration of the drum membrane is present, as is. indeed 
obvious; dry perforations are, however, a less serious 
matter than such as are discharging. It is curious how 
individuals differ as to the likelihood of water penetrating 
the external meatus, so as to reach the tympanic mem- 
brane and cause distress even in a normal subject, possi- 
bly harm in one already suffering from otitis media. 
The uncertainty in this regard in the particular child 
under treatment makes any prediction impossible; it is 
therefore wise, in my judgment, not to permit sea bathing 
in case there is any discharge, present or recent; also to 
proceed cautiously in patients with a persistent perfora- 
tion, even if otitic manifestations have been absent for 
years. If this safe rule be not followed, there will in- 
evitably be an occasional disaster to remind the prac- 
titioner that the entrance of sea water into the ear is not 
an indifferent matter, and he is pretty sure to be blamed 
severely, even unduly, if the risk was taken with his 
advice. 

For the winter, I should be inclined to recommend 
rather mild resorts for children with otitis media, the 
same as for catarrhal affections in general, and for 
similar reasons. After all, the disease of the ear is 
usually a complication of or sequel to an inflammatory 
trouble in the uppermost respiratory region, and must 
be treated more or less as an integral part thereof. This 
is also the reason why this group calls for discussion in 
this place, following the consideration of the respiratory 

1 Zeitschrift fur Ohrenheilkunde, 1900, vol. 36. 

2 Monatsschrift fur Ohrenheilkunde, September, 1899. 



VISCERAL DISEASES 325 

tract. In pursuance of this same trend of argument, 
it also seems a good idea to refer patients with a free 
discharge, especially when associated with a hyper- 
trophic catarrh of the nose or naso-pharynx, to moder- 
ately elevated and fairly dry inland localities instead of 
the seashore. 

The scantiness of the literature on aural climatology 
is intimately connected with an excessive devotion to 
routine in the application of this form of therapeutics; 
there has been no individualization to speak of, hence 
the dearth of satisfactory special articles. Neither has 
any attention been paid to the possible value of a change 
in atmospheric pressure, such as is involved in a removal 
from our lowlands to the Rocky Mountain Region. This 
might be considered in connection with the earlier stages 
of otosclerosis, as met with in childhood, the only age at 
which much can be accomplished. The otologists have 
still to determine whether such a climate as that of 
Colorado tends to check or further this disastrous lesion ; 
the subject certainly calls for a detailed investigation, 
which might profitably include a study of the effects of a 
reversal of the change mentioned, namely, from the high 
western plateaus to the sea level. 

DISEASES OF THE HEART 

There are but scanty data on the climatic manage- 
ment of heart disease in children, for, here again, most of 
the work extant relates to adults, and is not always 
applicable to the very different conditions found in the 
young. The chronic cases, which alone concern us here, 
fall clinically into the compensated and uncompensated 
groups, but the dividing line is marked less clearly than 



326 THE CLIMATIC TREATMENT OF CHILDREN 

in adults; on the other hand, the effects of a rational 
therapy are more rapid and satisfactory, for the almost 
invariable absence of irreparable myocardial and vascular 
degeneration aids us materially in re-establishing the 
balance of the circulation. The greater part of the field 
before us is covered by valvular heart disease of the 
rheumatic type ; we shall begin with the cases that pre- 
sent complete or tolerable compensation. 

Compensated Valvular Lesions. In the adult, a perfectly 
compensated valvular defect does not usually require 
continuous surveillance; with a fairly intelligent pa- 
tient, it is generally possible to enforce a regimen as to 
diet and exercise that will keep matters running quite 
smoothly for years and even decades. These remarks 
do not apply to children. Just as compensation is 
rather easily established in them by appropriate treat- 
ment, so it is more readily upset by adverse influences, 
among which, apart from the great and peculiar risk of 
intercurrent febrile affections, there is the difficulty of 
regulating the amount of muscular exertion. It is not 
easy to keep a child from violent play, still more difficult 
to obviate the strain involved in frequent and rapid 
stair-climbing. Now that the New York Department 
of Education is building schools on sky-scraper lines, 
without elevators, an ironclad "system" compels chil- 
dren suffering from valvular heart disease to ascend some 
sixty feet of stairs several times a day at an almost 
military pace. It is surely time for the medical frater- 
nity to call attention to this grave abuse, which a tenant 
in an office building would not tolerate for a day, I can 
personally recall several cases in which protests were una- 
vailing, and a child with barely adequate compensation 



VISCERAL DISEASES 327 

was compelled to choose between attending a class on the 
top floor or doing without schooling altogether. Such 
are the consequences of a routine in which the individ- 
ual is completely submerged. 

Children with perfect compensation do not demand 
systematic climatotherapy, with the exception of guard- 
ing against enervation; moderate exercise is absolutely 
essential, for any tendency to flabbiness is a rather 
serious matter ; it is therefore wise to select a fairly cool 
climate for the summer months. In the precise choice 
a little discrimination will be necessary, according to the 
localization of the lesion and the stability of the compen- 
sation. Compensated mitral cases, especially where 
regurgitation is the main feature, do well at considerable 
elevations; thus, Galli 1 obtained very favorable results 
at 3,800 feet in the Alps, Determann 2 does not think 
the Engadine too high in carefully selected cases, and 
Babcock 3 arrives at a similar conclusion with regard to 
the Rocky Mountains. So much can be said with some 
confidence, that these cases do not belong at the warmer 
and often sultry seaside resorts, where they are apt to 
lead a rather indolent life, especially in the case of girls 
approaching puberty. Such children are sure to do 
better at a somewhat elevated site, where the nights 
are cool, and the days rarely oppressive; the northern 
Alleghanies afford no end of suitable localities, but the 
watering places of Central Europe seem to be even 
superior, and indeed often well worth the trouble and 
expense of an ocean voyage. 

A severe mitral obstruction, even if fairly compensated, 

1 Riforma Medica, March 23, 1904. 

2 Loc. cit. 

3 Medical News, July 15, 1899. 



328 THE CLIMATIC TREATMENT OF CHILDREN 

must be treated with less strenuousness, and the com- 
bination with a lesion of the aortic valve requires the 
exercise of considerable caution, for fear of disturbing a 
balance at best somewhat labile. These children are 
often benefited very greatly by removal to a southern 
region during the winter, avoiding, of course, excessive 
warmth as tending to enervate instead of tone up the 
patient. Such resorts as Florida and Egypt are less 
desirable than the lowlands of Virginia, the southern 
Alleghanies and Pine Belt, the south slope of the Alps, 
and the foothills of the Pyrenees, as at Pau. The reader 
will not fail to observe how strenuousness is gradually 
discarded as we pass on to the borderland between com- 
pensated and uncompensated cardiac disease. 

Cardiac Insufficiency. This clinical picture obtains 
when compensation for a valvular defect has not yet 
been established by hypertrophy of the myocardium, 
also when the seat of disease is the heart muscle itself. 
As in the case of muscular insufficiency everywhere, such 
cases require a most judicious adjustment of rest and 
exercise, and every patient must be regarded individu- 
ally in the administration of these opposite therapeutic 
measures. Some general rules may, however, be laid 
down by way of introduction. The high levels, in the 
first place, are absolutely contraindicated, for their unre- 
mitting stimulation to the heart action is likely to be 
harmful; it is distinctly dangerous to add to the strain 
on an organ already insufficient, and requiring rest, not 
exercise; for the same reason the colder seaside resorts 
are not to be thought of. On the other hand, the warmer 
marine stations are apt to cause enervation after a time, 
so that the usefulness of the oceanic climates is rather 



VISCERAL DISEASES 329 

limited in this group of patients. Still, the Riviera, 
southern California, and similar regions may be of value, 
in selected cases, during the cooler months; and during 
the summer the coast of southern New England may 
prove salutary; most other coast stations are too cold 
or too warm, and especially too windy, to affect uncom- 
pensated heart lesions favorably. 

We are, therefore, almost entirely restricted to inland 
resorts at or reasonably near the sea level, with a tem- 
perature permitting a very quiet outdoor life, yet not 
enervating. The range thus afforded is still considerable, 
varying of course greatly with the season, for it goes 
almost without saying, and cannot be too clearly under- 
stood by the attendant, that the climatic treatment of 
cardiac insufficiency is a matter, of many weeks' dura- 
tion, if relapses are not to set in promptly. In com- 
mencing with a case of some severity, but still in a 
chronic or sub-acute stage, it is best to begin with a 
climate just too cool to be enervating. In midwinter 
northern Florida, southern Georgia, Sicily, southern 
California and the Riviera are eminently suitable; we 
may then, toward spring or as the patient improves, 
advance to a somewhat more northerly and bracing 
climate, without, however, seeking true stimulation, 
which we shall do well to reserve for the time of appar- 
ently restored compensation, as a sort of after-cure. For 
the last, a mountain resort, not over 3,000 feet high, 
is of some value; it is sufficiently bracing to have a 
tonic effect, and serves as a sort of test of the efficacy of 
the preceding rest cure. 

It is impossible to exercise too great discrimination in 
the climatic treatment of cardiac insufficiency ; all stages 



330 THE CLIMATIC TREATMENT OF CHILDREN 

from a rather labile compensation to almost total heart 
failure are met with, and nearly all may be benefited 
by an exactly appropriate climate. With children we 
may look for excellent results in conditions that are 
almost desperate in later years, so great is the recupera- 
tive power of the myocardium at an early age. 

It is not within the scope of this work to discuss the 
methods and admirable results achieved at such places 
as Nauheim ; we shall merely mention that an important 
element of this treatment is the general hygienic regula- 
tion, with a large proportion of climatotherapy. The 
best evidence of this is the great inferiority in results 
obtained by means of the so-called Nauheim cures in our 
cities; and one season's sojourn among the hills of middle 
Germany between May and September is a convincing 
argument that the climate there, during those months, 
is hardly rivaled and certainly unsurpassed. Only in 
certain hilly sections of New York and New England, so 
far as this continent is concerned, can we secure a similar 
combination of pleasantly warm days and cool nights, 
moderate humidity, and not excessive rains; unfortu- 
nately, the medical skill that frequents the German 
spas is conspicuous by its absence at nearly all similar 
resorts in this country. It is unnecessary to add that 
the accurate imitation of the baths themselves is the 
easiest part of the whole problem, and within the scope 
of any competent chemist; moreover, very similar springs 
exist in this country; the surroundings, however, in the 
shape of well-kept roads and woods, with level paths, 
also first-rate medical attendance and hotel accommoda- 
tions, are rudimentary or absent at most of our resorts, 
and up to the German standard at none. It is really 



VISCERAL DISEASES 331 

astonishing that American invalids should be almost 
compelled to seek health four thousand miles away, 
when equally good opportunities might he at their very 
doors. 

Congenital Heart Disease. Most cases of congenital 
heart disease have little chance of viability beyond 
puberty or adolescence, but there is a certain proportion 
in whom the prognosis is relatively good under careful 
handling. These more favorable cases are usually dis- 
tinguishable on inspection by the absence or slightness 
of cyanosis, though this is not invariably the case; 
markedly cyanotic subjects have survived to middle life 
and beyond. Very little has been done in regard to 
studying the climatic treatment of these patients, but 
a few general points suggest themselves readily. Thus, 
H. Vierordt 1 wisely proposes wintering in a mild climate; 
he does not specify very precisely, but an exact recom- 
mendation is not possible for a condition whose severity 
varies so widely. We are once more called upon to 
exercise discrimination, selecting a rather bracing climate 
for well-compensated cases, with little dilatation and 
no cyanosis of consequence, sending the severe types to 
warmer resorts, but reserving the truly relaxing climates 
for such patients as offer a rather poor prognosis in any 
event. Vierordt' s standpoint in advising against even 
moderately high elevations seems wisely taken, and I 
would extend this to include the colder and windier sea- 
side resorts; congenital heart disease does even worse 
under undue strain than an acquired lesion, and an upset 
compensation is often never re-established, even in the 
very young. In some of the most promising cases, the 

1 Nothnagel, specielle Pathologie und Therapie, vol. 15, part 2. 



332 THE CLIMATIC TREATMENT OF CHILDREN 

balance of the circulation is apt to be more unstable than 
appears On physical examination, for we must remem- 
ber that, in the congenital group, we are dealing with 
imperfectly diagnosticable lesions, whose gravity cannot 
always be gauged when matters seem to be going on 
fairly well. 

Pericarditis. For our purposes only the cases of peri- 
cardial adhesions sufficient to impede the heart action 
need be considered; when the lesion is so serious as to 
produce this effect the prognosis in regard to complete 
restitution is regularly unfavorable, for the circulatory 
impairment tends to grow steadily worse. One of the 
few measures that have any value in this condition is 
removal to a moderately warm climate at a low level, 
where the smallest possible demands are made on the 
heart. In these, as in the more severe congenital heart 
cases, it is probably the wisest plan, whenever feasible, 
to determine on permanent residence in such a region as 
southwestern California, one of the few sections that 
offer a comfortable climate throughout the year, for 
most of the other mild winter resorts become excessively 
hot in summer. Such a change of abode is the more 
desirable, as otherwise an annual long jouney, with its 
risks and annoyances, is inevitable ; we are dealing with 
conditions that are irremediable, and our only thought 
must be to prolong life with comfort. If an isolated case 
may be restored to partial efficiency by this, almost the 
only promising measure, continuance of the achieved 
amelioration is also largely dependent on favorable cli- 
matic conditions, so that in any event a choice of the 
sort mentioned will be wisely made, provided that the 
circumstances of the child's family permit a radical and 



VISCERAL DISEASES 333 

permanent change of base without involving too serious 
financial impairment. 

DISEASES OF THE NERVOUS SYSTEM 

The discussion of the climatotherapy of nervous dis- 
eases in childhood presents certain difficulties in classi- 
fication, but it will suffice, for our purposes, to divide 
them into groups calling for similar treatment, without 
going too far into pathological details. 

Nervous Irritability and Nervous Exhaustion. It is 
best to avoid the much abused term neurasthenia in this 
connection, both because that designation is rather 
inaccurate to begin with, and for the reason that the 
picture described under that name in adults is rare in 
childhood. On the other hand, early life has some char- 
acteristic clinical groups of its own that are plainly 
manifestations of subnormal or perverted nervous func- 
tions, yet cannot be regarded as neurasthenic in the 
current sense. 

The nervous disorders here discussed rarely exist alone, 
but are usually associated with visceral derangements, 
simple malnutrition or one of the other chronic nutri- 
tional or systemic diseases noted in the preceding chapter, 
sometimes scrofulosis or lymphatism, and so on. This 
contrasts markedly with the state of affairs in the so- 
called neurasthenia of adults, which is often associated 
with almost normal vegetative functions. 

Nervous irritability may appear at a very early age, 
even in infancy, though nervous exhaustion is commoner 
in the very young. When, however, we remember that 
there is no hard and fast line between these conditions, 
which are indeed often mutually interdependent, we 



334 THE CLIMATIC TREATMENT OF CHILDREN 

shall have no trouble in recalling infants who showed 
more fretfulness and capriciousness than nervous ineffi- 
ciency, and might properly be classed as irritable. The 
general nutrition of the child suffering from nervous 
irritability tends to be subnormal, though this is not 
constant; careful examination will usually elicit one of 
the deficiencies or diseases mentioned above. In the 
way of direct etiology, we regularly obtain a history of 
faulty training; the patient eats unsuitable food and 
has vicious habits of eating; there is a tendency to ex- 
cessive mental application and too little life out of doors. 
Then, there are such items as too much association with 
older persons, sensationally minded nursemaids, ghost 
stories, late hours, children's parties, and no end of 
such other indulgences and perversions as are occupy- 
ing the time and energies of the young to an increasing 
extent. 

The most characteristic symptom in these cases is a 
disturbance of sleep. In the mildest ones, the child 
merely finds difficulty in falling asleep, and is apt to 
wake up occasionally during the night; those more 
severely affected dream vividly, the apparitions ranging 
all the way from mere passing impressions to horrible 
nightmares and night terrors; grinding of the teeth dur- 
ing sleep and somnambulism are mere variations, and 
most of the cases of nocturnal enuresis undoubtedly 
come under this head. Only the very worst cases suffer 
from real insomnia, characterized by long waking spells 
during the night, with a tendency to unconquerable 
drowsiness in the early morning. In this last group, 
nervous exhaustion is sure to supervene in the course of 
time, somewhat confusing the clinical picture. 



VISCERAL DISEASES 335 

The child afflicted with nervous irritability is also 
quite certain to exhibit characteristic manifestations 
during the daytime. In the first place, it is highly 
emotional, being moved to tears or laughter by the merest 
trifles; it has also a morbid fondness for the impressions 
that produce these psychical outbursts, and often an 
inclination toward moroseness or introspection, apt to 
be mistaken for precocity by persons who habitually 
underrate the intelligence, mental activity and curiosity 
of normal children. Secondly, such children are fre- 
quently addicted to daydreaming, a state of auto- 
suggestibility which they induce in themselves with 
increasing readiness and profoundness, as the neurotic 
condition progresses. Thirdly, the temper is highly 
unstable, the temptation being great to set this down 
to defective training; it is so in a sense, but not the or- 
dinary one; these children are not merely spoiled, accus- 
tomed to having their own way, and without respect for 
authority; on the contrary, they are likely to be well be- 
haved toward their elders, and models of obedience under 
ordinary circumstances. Their outbursts are always 
more or less irrational, unpredictable, and altogether 
out of proportion to the exciting causes; they are more 
apt to disagree with their playmates than with their par- 
ents or teachers. 

In our last statements we may, perhaps with some 
justice, be accused of wandering from the subject, for 
the general picture we have given bears some resemblance 
to, and foreshadows, the true psychoses. These are in 
fact a frequent later phase of the nervous irritability of 
childhood; degeneration into hysteria is quite common 
with the approach of puberty, the supervention of one 



336 THE CLIMATIC TREATMENT OF CHILDREN 

of the juvenile forms of dementia is a matter of frequent 
record, the relation to migraine and epilepsy is more 
doubtful. In addition, many persons who suffer from 
various types of insanity in later life, exhibit the above 
picture in childhood, notably when they bear the heredi- 
tary taint of a degenerative neurosis or psychosis; in 
these individuals the symptom group I have called nerv- 
ous irritability is merely a prodromal stage. Unfortu- 
nately, it is just the neuropathic parents of such a child 
who are most* likely to be proud of its "high-strung" 
disposition, and who overburden its mind in the hope of 
developing a genius. It is true that genius is peculiarly 
apt to be associated with just such antecedents, but real 
genius develops spontaneously, without artificial foster- 
ing; more harm, indeed, is done by cramming the minds 
of these children than of those apparently less gifted 
but better balanced. 

The main and almost sole indication in these cases is 
rest; to further this there is nothing so effective as a 
change of air and scene to quiet, even monotonous, sur- 
roundings. In this regard the matter of climate is not 
indifferent, knowing; as we do, that climate may be a 
powerful stimulant as well as a sedative; as usual, it is 
easier to caution than to advise, but both are quite 
feasible. Evidently, hot summers, cold winters, great 
elevations, excessive drought, and high winds are to be 
shunned; in addition, of course, we must place an 
absolute ban on city life, with its nervous wear and tear. 
Our first object should be to select a fairly genial and 
moderately moist locality, at a low or moderate eleva- 
tion, where an outdoor but restful life can be led to its 
fullest extent. Often, therefore, mere removal from the 



VISCERAL DISEASES 337 

city. to the suburbs will achieve the end in view, for the 
irritation caused by the constant and fearful noises of an 
American city renders amelioration impossible; it is to 
be understood, naturally, that the neighborhood of rail- 
way stations and factories may impair even a rural site 
very greatly, for our purpose. Other physical, notably 
hydro therapeutic, measures, of great value in this con- 
dition, do not concern us here, and will not be dwelt 
upon. 

The clinical picture of nervous exhaustion, in its 
typical development, is quite different. Combinations of 
nervous irritability with nervous exhaustion are frequent, 
and the relative predominance of one or the other of 
these elements is often puzzling; in treating such cases 
the wisest plan is to consider the latter first, although 
the former is usually primary. 

Cases of nervous exhaustion almost invariably present 
one of the before-mentioned disturbances of nutrition; 
the keynote to the entire situation is inadequacy to 
meet the normal demands on the nervous system; its 
characteristic psychical expression is best described as 
apathy. The details previously recounted under the 
heading of malnutrition fit this group fairly well, if we 
allow for the relatively greater prominence of nervous, 
as opposed to visceral, inefficiency. Our procedures also 
follow closely the rules laid down in the discussion of 
nutritional diseases, with certain modifications, to allow 
for the neurotic factor. 

In the more severe forms, where the affected child 
seems totally devoid of nervous energy and will power, 
and disinclined to anything like physical or mental 
exertion, even play, we must begin with a somewhat 



338 THE CLIMATIC TREATMENT OF CHILDREN 

relaxing climate, that permits sitting and lying in the 
open air most of the day, without having to consider the 
question of warmth; the last point presents some little 
difficulty, in that these patients require a temperature 
somewhat higher than is advisable for normal children. 
After distinct improvement has set in, a more bracing 
climate should be sought without delay, for enervation is 
particularly undesirable in neurotic patients. On the 
other hand, it is a grave error to inaugurate the treat- 
ment of severe cases with removal to a mountain resort, 
and the benefit of high altitudes, even when improve- 
ment has clearly set in, is very doubtful. S. Brown 1 and 
Pearce 2 have pointed out that the limit for bad cases is 
a few hundred or, at the most, 1,000 to 1,500 feet; as 
progress is noted an ascent may be made to 3,000 feet, 
but this is the outside extreme. In the Rocky Moun- 
tain districts the intense stimulation of bright and almost 
unremitting sunshine, sudden and frequent changes of 
temperature, and the excessive dryness Of the air, is apt 
to aggravate rather than ameliorate the child's condi- 
tion; 'insomnia is apt to come to the front as a distress- 
ing and ominous symptom. The good results noted by 
Determann 3 and Krafft-Ebing 4 in certain phases of the 
torpid neurasthenia of adults bear little if any relation 
to the subject here in hand, the type of disease referred 
to is of more than doubtful occurrence before adoles- 
cence. We may, furthermore, even at the risk of ap- 
pearing wearisome through repetition, again refer to the 
different reaction of children, as opposed to adults, with 

1 New York Med. Journal, July 17, 1897. 

2 Ibid. October 5, 1901. 

3 Loc. cit. 

4 Nothnagel, spec. Path. u. Ther., vol. 12, part 2. 



VISCERAL DISEASES 339 

respect to hardening procedures, among which removal 
to cool climates at high elevations unquestionably be- 
longs; in fact, Hecker, 1 as before stated, observed that 
systematic hardening entails conspicuously bad results in 
this very group of children. 

The more bracing seaside resorts are almost or quite 
as harmful in the severer stages of this neurosis. We 
may again refer to the remarks by Ide 2 on the over- 
stimulation due to high winds and excessive sunlight, 
including its reflection from the water, sand, and rocks; 
these agents have anything but the sedative effect that 
is urgently demanded by the victims of nervous exhaus- 
tion. In milder cases, however, or in the severer ones 
when a distinct improvement has been noted, such mild 
seaside resorts as southern New England and Long 
Island from June to October, and the South Atlantic 
Coast during the winter, with Atlantic City or Old Point 
Comfort as an intermediate station, may be chosen with 
every prospect of success. The west coast of Europe is, 
speaking generally, rather too stimulating; Perier, 3 for 
example, does not recommend either the Channel or 
southwestern resorts for neurotic children, though he 
looks on the Mediterranean shore with favor. It appears, 
however, that the resorts along the English Channel and 
the Baltic Sea, as well as on the New England Coast, 
from Bar Harbor southward to Boston, are invaluable 
as an after-cure, when also sea bathing, cautiously ad- 
ministered, is sure to be beneficial. The really raw 
marine climates, such as are found in our far Northeast 
or Northwest, or along the North Sea, are best avoided 

1 Loc. cit. 2 Loc. cit. 

3 Loc, cit, and Annales de med, et chir. infantiles, 1899, p. 613. 



340 THE CLIMATIC TREATMENT OF CHILDREN 

altogether; the more so as sea baths are entirely out of 
the question in those parts. 

Our main reliance in treating the neuroses of children 
are the low or slightly elevated inland localities, where 
our range of choice is fortunately ample, for the exact 
temperature need be regarded only in the very severe 
cases. Such places as the Italian Lake Region, southern 
Tyrol, the Lake of Geneva, praised by Bergougnian/and 
our southern Alleghanies, are not too cold, even in mid- 
winter, for the milder neuroses, save possibly in excep- 
tionally severe seasons ; all the warmer stations, short of 
those that are actually subtropical, are likewise eligible. 
Good judgment should, of course, be exercised, and here 
also, as in the treatment of malnutrition, I should prefer 
to individualize according to age, and reserve the colder 
group of resorts, during the winter months, for children 
of the school age; they are, however, excellent spring 
and autumn stations for all ages, and cannot be recom- 
mended too highly in this respect. 

In summer, all the moderately elevated sites, in the 
Middle Atlantic and New England States, as well as 
central Europe, are available and quite sure to be useful. 
In the Pacific States a choice must be made with some 
care, but the great valleys of western Oregon, and many 
places in the interior of Washington are quite good from 
June to September, the dry season. 

A few words may be added on nervous exhaustion in 
infants, of which Northrup 2 adduces some typical 
examples at ages of only a few months. In such cases 
the home surroundings are so evidently at fault, that a 

1 La p&Iiatrie pratique, 1903, No. 3. 

2 Archives of Pediatrics, January, 1905. 



VISCERAL DISEASES 341 

change of climate will effect little, if anything, unless 
assisted by a correction of the mismanagement of the 
baby, and the installation of an intelligent nurse. With 
these improvements, however, satisfactory results may 
often be attained at home, and a long trip avoided, 
though frequently, in the colder months, removal to a 
genial climate, and in summer a stay in the country, 
will facilitate a cure very materially. This phase of the 
subject is only now arousing attention, but its importance 
cannot be overrated ; it is reasonably certain that many 
cases of nervous exhaustion in children have been as- 
siduously cultivated from earliest infancy. 

Enervation. The condition somewhat loosely called 
enervation, referred to so frequently in this work, is of 
particular interest to the medical climatologist, and 
merits an extended discussion. We may begin by 
observing that enervation is not properly a form of 
nervous exhaustion, but of debility, analogous to the 
condition in the muscular system called flabbiness, as 
distinguished from tiredness. It is characterized by a 
deficiency in reactive power in responding to ordinary 
meteorological as well as other physical stimuli; the 
patient has either not been trained to resist untoward 
influences, or has forfeited this faculty from disuse; he 
is therefore in a condition the exact reverse of hardened. 

In addition to distinguishing enervation from nervous 
exhaustion, we must also differentiate it from certain 
types of neurasthenia, common in adults, but rare or 
unknown in children, where the symptom of sluggishness 
is the misleading factor; outside of this torpidity, the 
two diseases have almost nothing in common. 

I have attempted to draw up a small diagnostic table 



342 



THE CLIMATIC TREATMENT OF CHILDREN 



illustrating nervous irritability and exhaustion, and 
enervation; the reader must understand, however, that 
the data given therein are to be employed only as guides. 
Combination of any two or all three of these neuroses are 
quite common; the one fact alone, that the enervated 
nervous system is especially liable to overexcitation or 
exhaustion accounts for this circumstance sufficiently. 





Nervous 
Irritability 


Nervous 
Exhaustion 


Enervation 


1. General appearance 


neurotic 


apathetic 


flabby 




normal or sub- 
normal 


subnormal 






above normal 


3. Susceptibility to physical 


normal 


increased 


very great 




4. Emotional susceptibility. 


excessive 


subnormal 


normal 




" capricious 


subnormal 








6. Psychical energy 


excessive 


subnormal 


normal or sub- 
normal 


7. Vegetative functions .... 


irregular 


subnormal 


sluggish 



The observations under the first heading characterize 
these three groups well, in a general way. In enervation, 
as will be observed from the table, nearly or quite normal 
mentality is associated with a subnormal physique, in 
nervous exhaustion the impairment is more diffuse, but 
affecting the psychical functions rather more than the 
physical. The keynote to nervous irritability is capri- 
ciousness and unstableness. 

The etiology of enervation consists essentially in pam- 
pering and coddling. The patient has lived in too warm 
and even a climate, or has been protected from adverse 
weather conditions more than necessary or advisable. It 
is, therefore most apt to be encountered among the resi- 
dents of southern latitudes or well-to-do families farther 



VISCERAL DISEASES 343 

north. The logical treatment, of course, is hardening, 
and this might be adopted in the adult at once and with 
considerable strenuousness. We have, however, seen 
the untoward effects of severe measures in young chil- 
dren, and must therefore modify this plan very materially 
at that time of life. Transfer to a cooler climate, be- 
ginning in the late spring, whenever possible, is perhaps 
the least harmful method of hardening, and we may 
thus gradually accustom such children to northern 
weather; To advance to this degree is, of course, only 
desirable if a permanent change of residence is held in 
prospect, otherwise it is quite useless to go to the trouble 
of gradually inuring southern children to the rough con- 
ditions of higher latitudes. For such as are to return 
South, removal for the summer only is called for; the 
locality selected should be decidedly cool, averaging 
64 to 66 degrees for older children and 68 to 70 for 
infants, in July and August. 

A good practice for residents of such very enervating 
climates as that of our Gulf Coast is to send their children 
North toward the end of April or beginning of May, when 
the mean temperature rises into the seventies, arid not 
permit their return until well on in October. Such a 
measure naturally entails heavy expense, also consider- 
able trouble, but the reward is reasonably sure, for the 
summer of the far South is extremely injurious to very 
young children, making them excessively susceptible to 
the first cool nights of September «or October, even when 
the summer itself has passed without severe illness. It 
is worth noting that children born in the North have 
great difficulty in becoming acclimated in our southern- 
most sections; they become badly enervated in a few 



344 THE CLIMATIC TREATMENT OF CHILDREN 

months, apparently far more thoroughly than the natives, 
and the consequences are most serious. It is commonly 
assumed that the chief danger to such children lies in 
acute or chronic diseases of the alimentary tract; this 
peril does exist, but is exceeded by the extreme risk of 
contracting fatal respiratory affections from trivial ex- 
posure. Crombie 1 has effectively dwelt on this circum- 
stance in the typically, but not in the very highest 
degree, enervating climate of India, where the mortality 
of pneumonia in young children amounts to fifty per 
cent., though the morbidity from that disease possibly 
does not equal that of northern regions. We have 
noted, in the first chapter, the high death-rate from this 
disease in our southeastern states; the cause is undoubt- 
edly the same as in India. 

Insomnia. The question whether or not a patient is 
suffering from insomnia is not to be decided merely by 
counting the hours of sleep, but requires a somewhat 
complicated and searching analysis. Holt gives the 
normal amount of sleep as follows : 





Age 


Hours 




14—15 




13—14 




11 — 12 




10—11 




9—10 







Children vary, however, very much as do adults; a 
range of an hour or more in either direction is still com- 
patible with normal health. The seasonal variation 
must likewise be regarded; about an hour less than the 
above figures is required in summer, as much more in 

1 British Medical Journal, Sept. 14, 1901. 



VISCERAL DISEASES 345 

winter. A child of one year may, therefore, demand as 
much as 17 hours of sleep in winter, and as little as 12 
in summer, without the necessary inference of anything 
pathological. 

A history of interrupted sleep is most important; 
never quite normal in the adult, it is distinctly morbid 
in childhood, and if not dependent on external influences 
(noises, etc.) or physical pain, becomes an exquisitely 
neurotic manifestation, usually associated with general 
nervous irritability. It is rare to note this symptom 
without evident sequelae in the early waking hours, such 
as general torpor, peevishness, and an impaired appetite 
at breakfast;, indeed, the absence of all of the latter 
symptoms justifies a skeptical attitude as to the entire 
history. As previously mentioned, the severe types of 
insomnia are rare in children; it is therefore all the more 
essential to look out for the minor form just described, 
which is likely to be the precursor of more serious 
disturbance. 

With regard to the influence of climate on insomnia, 
we may begin with reference to the data in MacFarlane's 
admirable monograph. 1 Adverse influences are severe 
cold, intense heat, especially when associated with a 
high humidity, and high elevations. As to the first, we 
must, of course, differentiate from the deepening and 
ultimately fatal coma that results from a marked lower- 
ing of the body temperature; the first effects of a low 
temperature are irritant, and contribute to wakefulness. 
The irritation due to great heat and humidity has already 
been touched upon, and the general relative anaemia, 
with its inevitably concomitant cerebral irritation, 
1 Insomnia and its Therapeutics, New York, 1890. 



346 THE CLIMATIC TREATMENT OF CHILDREN 

following removal to high levels, has also obtained ample 
notice in the first chapter. 

The effect of the seaside has been recorded variously 
as favoring or relieving insomnia. MacFarlane's remarks 
as to the former may very well apply to the cool and 
bracing northern coast resorts, whereas the American and 
other references to the sedative influence of the sea air 
are certainly more generally applicable. Still, Pearce x 
reports a case that suffered from the high winds at 
Atlantic City, but obtained relief at Philadelphia; it is 
doubtful if any other city in this country can boast of a 
parallel achievement, save possibly in the outer suburbs. 

All authorities seem to agree on the benefit to be 
derived from a sojourn at moderately elevated and 
reasonably mild inland stations. 

The Spasmodic Affections. For our purposes we may 
throw this heterogeneous assemblage of diseases under 
one heading, to save space. Chorea, of the rheumatic 
type of Sydenham, requires detailed and distinct con- 
sideration, for, apart from any associated articular or 
cardiac symptoms, it is likely to undergo considerable 
amelioration in a suitable climate. We may distinguish 
between two sets of chorea cases, namely, the mild and 
the severe, as they present a clinically very different 
picture, and call for entirely different treatment. The 
milder cases, well nourished, and in generally fair condi- 
tion, require only the moderately sedative regimen 
indicated in other cases of nervous irritability. The 
severe cases, however, which present symptoms of physi- 
cal as well as nervous exhaustion, are often serious enough 
to call for rest in bed as a preliminary treatment, followed 

1 Loc. cit. 



VISCERAL DISEASES 347 

by removal to a very mild and sedative climate, even one 
of those near the enervation point, which are too relaxing 
for most invalids. After all', however, we are here apply- 
ing a treatment similar to that advised for nervous ex- 
haustion, only in a still higher degree. Of course, as 
progress is noted, it is well to transfer the patient to a 
more bracing climate; in any case, several months will 
be required for a cure. 

The habit spasms, including tic convulsif and stam- 
mering, may be benefited by the treatment accorded to 
cases of nervous irritability in general, of which they are 
common manifestations. The nodding spasms of infancy 
are generally associated with a nutritive disturbance, 
usually rickets; here the indication is to treat the under- 
lying condition. Epilepsy is amenable to climatother- 
apy only to the extent that a good climate will benefit 
anybody. 

The secondary spastic conditions associated with 
spinal disease require no separate treatment; we need 
attend only to the patient's general condition. As a rule, 
the plan outlined for malnutrition will yield the best 
results; I would also call attention to the recommend- 
ations in the following paragraph, concerning the at- 
tendant paralytic affections. In the spinal diseases of 
children we regularly find contractures and paralyses 
combined. 

The Paralytic Affections. These call for climatic 
treatment only indirectly. Children afflicted with par- 
alysis require an abundance of fresh air, but naturally 
cannot avail themselves of exercise to any extent worth 
mentioning. They, therefore, necessarily require a milder 
climate than such as are able to move about freely, and 



348 THE CLIMATIC TREATMENT OF CHILDREN 

must frequently be taken away from home for this 
reason. Other things being equal, the seashore com- 
mands our first choice; the moist and equable air from 
the ocean is particularly grateful to these little sufferers, 
and a judiciously followed course of sea bathing rarely 
fails to benefit the general health. In the management 
of the individual cases many variations will suggest 
themselves, such as a tolerably bracing climate in the 
later stages of poliomyelitis, and a more relaxing one 
in the earlier stages, before improvement has begun to 
set in; a fairly cool and dry climate in facial palsy, where 
general exercise is possible, but wet weather does harm; 
and a very mild region in post-diphtheritic paralysis, 
where the general condition may be far below normal. 
This field, as a whole, is rather difficult, and does not 
admit of the laying down of any hard and fast rules; the 
patient's state of nutrition is a valuable guide, ranking 
with the capacity for muscular exertion. In view of the 
rather empirical administration of climatotherapy to 
many of these subjects, the wisely discriminating physi- 
cian will often be astonished at the improvement in 
cases that made no progress at home; a stationary con- 
dition in these cases implies deterioration, in view of the 
secondary changes that are inevitable. It is true that 
some of these children might likewise have improved 
under adequate utilization of a fairly good home climate, 
but. it is a matter of daily observation that the mere 
reference to a well-known health resort seems to reawaken 
the dormant or flagging interest of* the parents. The 
recommendations of the attendant as to exercise, diet, 
bathing, etc., are invariably carried out with greater 
fidelity and exactness at a watering place than at home. 



VISCERAL DISEASES 349 

The Painful Neuroses. These play a comparatively 
small role in childhood, but we may nevertheless touch 
upon a few items of interest. Facial neuralgias in chil- 
dren are usually secondary to otitis media or dental 
caries, and call for treatment of the primary affection; a 
few cases, however, are independent of any such con- 
nection, and are then likely to improve on removal to a 
warm and dry climate. The relation of neuralgia to 
meteorological conditions is precisely similar to that 
described in the case of rheumatism (page 274) ; in this 
connection we may cite an interesting case reported by 
Weir Mitchell, 1 in which, during seven years, every storm 
brought on a neuralgic attack. Such a patient will 
naturally do far better in the western half of our con- 
tinent, where general storms are relatively more moderate 
and infrequent in the winter months than in the tem- 
pestuous climate east of the Rocky Mountains; the greater 
dryness westward would likewise afford the patient relief , 
as nothing seems to favor neuralgia quite so much as a 
high relative humidity. 

The status of migraine among the neuroses is at present 
in doubt, but a large mass of recent testimony seems to 
assign to this affection a position among the epileptoid 
diseases; such is pre-eminently the standpoint of the 
German school, and my own experience also has taught 
me to differentiate true migraine from the headaches due 
to gastro-intestinal intoxication. On the basis of the 
epileptoid theory, treatment of the digestive tract alone 
should be supplemented by the regime of rest recom- 
mended for the other spasmodic neuroses. Mendel 2 

1 American Medico-surgical. Bulletin, Mav 16, 1896. 

2 Deutsche med. Wochenschrift, 1906, No. 20. 



350 THE CLIMATIC TREATMENT OF CHILDREN 

recommends elevated inland climates in preference to 
the seashore; the indication thus agrees with that 
given for the neuralgic affections. Migraine is not at all 
a rare disease in children, but there are not yet extant 
sufficient data as to its climatotherapy to warrant more 
than the above suggestion. The subject has hitherto 
received little separate or detailed consideration. 

DISEASES OF THE SKIN 

The integument is the organ most conspicuously 
subject to adverse external influences, and might there- 
fore be expected to manifest great sensitiveness to the 
vicissitudes of weather and the variations of climate. 
It is true that modern clothing acts as a protection 
against these agencies, but its function is imperfect, 
incomplete so far as the head and extremities are con- 
cerned, and subject both to mismanagement and neglect 
because of the dictates of fashion and the stress of 
poverty. Yet this subject has received little, almost no 
attention, and one of the least frequent recommendations 
by the dermatologist is a change of climate. 

Many cutaneous lesions are quite independent of 
meteorological conditions,' but this is probably true only 
of the minority, if we regard the number of our patients, 
rather than the variety of diseases. It is no exaggera- 
tion to say that many thousands of sufferers from skin 
disease can be benefited greatly by a change of climate, 
and this is conspicuously true of children. Among typ- 
ically climatic dermatoses, prickly heat (lichen tropi- 
cus) is a characteristic example, for which removal to a 
different, in this case, cooler region is an unfailing spe- 
cific. Frostbites, chilblains, and the chronic • eczema 



VISCERAL DISEASES 351 

of the face and hands from which so many children suffer 
intensely in winter, are promptly benefited by transfer 
to a more genial zone. These two groups represent most 
exquisitely the respective effects of hot and cold weather 
on the skin, aided by a high degree of humidity in the 
former ailment, and apparently aggravated by a dry 
atmosphere in the case of winter eczema, though exces- 
sively frequent ablutions with cold water seem to play 
an important part in causing the latter. I have observed 
patients in whom a winter tour from one of the very 
damp lake cities (Cleveland) to the drier Middle Atlantic 
Coast brought on this disease with great promptness, 
though the temperature at the latter was decidedly 
higher. 

Too little attention has been paid to the climatic 
treatment of ichthyosis, though it is the obvious corollary 
to the regular alternation of improvement in summer and 
exacerbation in winter. The objection, of course, holds 
good that we cannot cure this disease, or rather mal- 
formation, and that removal to a mild and moist climate 
is merely palliative. Still such removal, for the winter 
in moderate cases, permanent in the severest forms, is 
worth serious consideration, in view of the great discom- 
fort these patients often experience. 

As to large groups of other cutaneous affections, it 
will suffice for us to generalize. In most chronic skin 
diseases it is not easy to separate climatotherapy from 
balneology, and these two forms of treatment should be 
combined more often than is the case. It should not be 
necessary to point out the absurdity of sending patients 
afflicted with skin diseases to the baths of northern 
latitudes in winter, or to the corresponding southern 



352 THE CLIMATIC TREATMENT OF CHILDREN 

resorts in summer, but the importance of a suitable cli- 
mate is very often ignored. The value of adequate 
climatological information to the dermatologist seems 
obvious, but its possession is rarer than we might justly 
expect; the appropriate combination of climatic treat- 
ment with the prescribed course of baths will be found 
invariably to increase the efficacy of the latter. 

Certain aspects of phototherapy might be referred to 
in this place, but this department of dermatology is too 
highly specialistic to be disposed of in a general treatise 
of this kind; the field, moreover, is still very new, and 
results are only just beginning to be reported. For an 
example of what is being done I shall merely call atten- 
tion to a recent paper by Guhr 1 on the heliotherapy of 
psoriasis; it is quite likely that we are on the threshold 
of some very interesting and valuable innovations in 
treatment, opening up an entirely new field in climatic 
therapy. 

1 Berliner klinische Wochenschrift, April 23, 1906. 



CHAPTER VII 

SCROFULOSIS AND TUBERCULOSIS 

The great bulk of the literature on climatotherapy 
relates to the treatment of scrofulosis and tuberculosis; 
the reader will be struck with the abundance of references 
on this subject, whereas the other applications of cli- 
matic treatment have not called for more than a few 
dozen articles within the past decade. It will, there- 
fore, be a relatively easy task to handle this chapter in 
a fairly thorough manner. 

In the adult the discussion of tuberculosis of the lungs 
covers practically the entire field, the other forms of this 
disease being numerically unimportant. In childhood 
the situation is altogether different; in the first place the 
more or less restricted involvement of the lung alone is 
extremely rare in infancy, and becomes comparatively 
common only toward puberty; secondly, childhood is 
characterized by polymorphous and more or less gener- 
alized tuberculous manifestations, besides an enormous 
group of affections, of which the tuberculous character 
is either obscure or doubtful. It is easy to see that the 
study of thjs subject in the young is not only broader and 
very much more comprehensive, but that it must also be 
regarded from a somewhat different point of view; in 
addition there is the constant differential appropriate 
to early life, which has been so often referred to on 
preceding pages. 

353 



354 THE CLIMATIC TREATMENT OF CHILDREN 

We can take up the entire question most advantage- 
ously by beginning with a consideration of the tuber- 
culous and pseudotuberculous affections peculiar to 
infants and children, commonly designated as scrofulous. 

SCROFULOSIS AND LYMPHATISM. 

In a monograph of this kind, concerned essentially 
with therapeutics, it is quite a serious venture to enter 
on an extended discussion of the relations to one another 
of tuberculosis, scrofulosis, and lymphatism, especially 
as complete agreement on the subject does not yet exist. 
A few remarks, giving a brief outline of the opinions at 
present prevailing, are, however, necessary and may not 
be superfluous. 

Cornet, 1 in his well-known monograph, distinguishes 
the following forms of scrofulosis: 

1. Tuberculous, caused by the tubercle bacillus; 

2. Pyogenic, resembling the former very closely 
Clinically, but caused by streptococci and staphylococci, 
not necessarily progressing to the formation of an 
abscess; 

3. Mixed tuberculous and pyogenic infection. 

The second group, only apparently tuberculous, yet 
undistinguishable save by refined laboratory methods, 
leads up to a series of cases that have often been caHed 
scrofulous, but are as frequently, nowadays, designated 
as manifestations of lymphatism. The term " lymphat- 
ism " at present includes a wide or narrow field, according 
to the taste and fancy of the author; for my part, I 
prefer to limit it to that group of infants and young chil- 
dren who have been variously described as suffering 
1 Nothnagel, specielle Pathologie u. Therapie, vol. 14, 






SCROFULOSIS AND TUBERCULOSIS 355 

from thymic asthma, congenital laryngeal stridor, or the 
status lymphaticus. The almost universally accepted 
view that this clinical picture rests on a glandular hyper- 
trophy, with marked predilection for the thymus gland, 
surely does not fit all cases, for such recent reports as 
Koplik's 1 show that many cannot be accounted for by 
enlargement of the thymus gland alone, and that lym- 
phatism represents a constitutional condition, related 
to those discussed in Chapter V. I have referred to this 
group here merely because of its clinical relation to the 
scrofulous glandular affections. 

A few words may also be added in connection with 
the adenoid hypertrophies of the upper respiratory and 
faucial regions, which were once regarded as typically 
scrofulous, but afterwards became relegated to the status 
of a local affection. The fact is that either aspect of the 
case may be correct, according to the individual. The 
majority of cases seem to be merely secondary to local 
inflammatory lesions, and I have therefore referred to 
them under the heading of chronic rhinitis and allied 
affections; there is no good reason, however, why they 
should not be placed in Cornet's second group of scrofu- 
losis. The maintenance of this standpoint is made the 
more justifiable through the researches of Wood 2 and 
others, who found tuberculous deposits in a fairly large 
percentage of these hypertrophies. It is clear that an 
accurate distinction is not within our clinical resources, 
and that these glandular affections may be dealt with 
here as properly as in the other connection mentioned. 

Fortunately, all the above theoretical considerations 

1 Archives of Pediatrics, December, 1905. 

2 Journ, of the Amer, Med, Association, May 6, 1905 f 



356 THE CLIMATIC TREATMENT OF CHILDREN 

have no great modifying influence on our therapeutic 
procedures, so far as the selection of a beneficial climate 
is concerned. ■ The indication in the entire group calls 
for a system of gentle hardening, applied, of course, with 
considerable regard to individual circumstances. It is 
much to be regretted that American authors have almost 
entirely neglected this extraordinarily interesting and 
important subject, whereas the contributions of foreign 
observers would fill many volumes; those quoted at 
intervals below constitute a relatively small part of the 
total. 

The seashore seems most favored by competent au- 
thorities, even in fairly cold regions. Thus Rode 1 re- 
cords very favorable results at Norderney, where the 
children do well even in the stormy but not intensely 
cold winter months; warm sea-water baths are adminis- 
tered three times a week. The other German sanatoria 
report similarly good results under similar management; 
a marked improvement is said to be effected in six weeks. 
Grebner 2 rightly claims that the percentage of complete 
cures would be even higher, if the regulations of the 
German sanatoria permitted a longer course of treatment; 
at present it amounts to about a third of the children 
admitted, though nearly all the remainder show some 
improvement. The French sanatoria have reached a 
somewhat higher state of efficiency, D'Espine's 3 recent 
report from Cannes being especially worth noting; the 
course of treatment averages five months, against six 
weeks at Norderney, and this accounts, at least in part, 
for the good results at that station, though we must not 

1 Loc. cit. 

2 Jahrbuch fur Kinderheilkunde, 1896, vol. 42. 
8 Archive de medecine des enfants.. 1904. 






SCROFULOSIS AND TUBERCULOSIS 357 

forget that Cannes is about twelve degrees warmer in 
winter, and has two or three times as many pleasant 
days. At the French sanatoria on the Mediterranean 
it is the custom to give the children sea baths through 
the winter; they are not intermitted even during cold 
spells, when the thermometer is near the freezing point. 
So strenuous a procedure seems to me of rather doubtful 
merit, in view of what we have learned of the effects of 
cold baths; the Mediterranean is remarkably warm in 
winter, but its temperature along the Riviera averages 
only 55 degrees in January and February; I am inclined 
to believe that these baths might well be exchanged for 
warmer indoor sea-water baths from December to March 
or April. 

D'Espine admits that the summer at Cannes is a little 
too warm; its temperature is similar to that around 
Delaware Bay; there is therefore considerable risk of 
enervation at that season. Dining the warm months, 
however, there still remain the resorts on the Bay of 
Biscay and the English Channel, on which Perier 1 and 
Robin and Binet 2 bestow the highest possible praise. 
Along the Bay of Biscay the water is. sufficiently warm 
for short sea baths in summer and early autumn. Weber 
and Foster 3 recommend the winter stations on the north 
shore of the English Channel only for robust children; 
for cases showing marked enfeeblement they decidedly 
prefer the Riviera. This opinion diverges somewhat 
from those we have quoted, since the Isle of Wight, for 
example, has a winter temperature about half way 
between that of Norderney and the warmest points on 

1 Loc. cit. 

2 Archive gen. de medecine, July 21, 1903. 

3 See bibliography. 



358 THE CLIMAT-IC TREATMENT OF CHILDREN 

the Riviera, with a fair number of sunny days, while the 
summer climate along the Channel is about the best in 
Britain. When we proceed to balance these opinions, 
we must consider that the German and French reports 
embrace a larger and more scientifically gauged material, 
whereas the British observers seem to have made a more 
thorough study of climatic minutise, often such as cannot 
be recorded by instruments of precision. 

An important point in deciding on the seaside in 
scrofulous cases is the presence of a dry catarrh; a ten- 
dency to febrile temperatures and pulse frequency also 
argues for one of these resorts, but in such subjects any 
tendency to bleakness should be avoided. 

Turning to American resorts, hitherto so sparingly 
exploited, we may find climates similar to the above 
from Long Island to northern Florida in the east, and 
from San Francisco to San Diego in the west, during the 
winter months; those farther north are too cold on the 
Atlantic side, and too wet and stormy on the Pacific. 
Of the eastern stations those north of the Virginia capes 
are somewhat too severe from the middle of December 
until the end of March, save for fairly robust children,- 
Atlantic City being quite as cold in winter as the North 
Sea coast of Germany, though far less cloudy; both have 
a tendency to high winds, which are apt to be damp and 
mild along the North Sea, but dry and piercingly cold 
in New Jersey, with temperatures at times near zero. 
All the stations on our Great Lakes are too raw, even the 
mildest are subject to violent storms and deep snow. 

In summer it is wise not to select climates that tend 
to enervate, and I should set New Jersey as the extreme 
southern limit even for enfeebled children; the coast 



SCROFULOSIS AND TUBERCULOSIS 359 

east and north of central Long Island is far preferable. 
In general it is safe to follow the rules laid down in the 
discussion of enervation. As to sea baths, we have 
noted the wide variations on our coasts, but may say 
that at the Atlantic stations, from Massachusetts south- 
ward, the water is often sufficiently warm in midsummer 
for a fairly long immersion that would be harmful in the 
colder waters of the Calif ornian or west European coast; 
we again repeat our caution against excess, and our 
counsel as to the avoidance of a strong surf. 

With these ample opportunities afforded on our side 
of the Atlantic, it is pitiful to record that our summer 
seaside sanatoria are both insufficient in number, and 
grant the patient far too brief a stay. As to winter 
sanatoria, but one exists/ opened so recently as the fall 
of 1904, whereas in effete Europe they have been flourish- 
ing for over half a century, the coasts being at present 
plentifully dotted with them. 

Inland resorts have been advocated less than those by 
the seaside ; they have certain advantages when there is 
an attendant moist catarrh, and in the obstinate and un- 
varying torpid cases presenting lethargy as a prominent 
feature. In treating these groups exposed plains are not 
so desirable as moderate elevations with a good wind 
shelter; the excellent results obtained at the German 
^ and French hill resorts may very well be repeated here, 
choosing such regions as the southern Alleghanies in 
winter, and the northern mountains in summer. In the 
former season the lower levels of the arid Southwest are 
also worth trying; Phoenix and Tucson are possibly a 
trifle too dry, but otherwise admirable, whereas San 
Diego and Los Angeles are a little too moist and relaxing 



360 THE CLIMATIC TREATMENT OF CHILDREN 

except in the case of very young, neurotic, or very 
delicate children. The more robust scrofulous patients 
urgently call for a considerable amount of hardening. 

In Europe flattering results have been achieved by 
combining one of these inland resorts with saline baths, 
furnished at a number of spas that afford a delightful 
climate between May and September. At these places 
it is possible to furnish a brine much more concentrated 
than sea water; 1 solutions up to ten per cent, and more 
are employed in treating the more robust subjects, where- 
as feebler ones do better by beginning with the isotonic 
strength of 0.9 per cent. The baths should be prolonged 
and warm, 95 degrees for enfeebled children, reducing to 
86 degrees for the more hardy ones. The indifferent 
temperature appears to be lower in salt than in fresh 
water, and the last-mentioned temperature is sufficiently 
high for a prolonged immersion in many cases. 

The rationale of this treatment is thought to lie in a 
general stimulation to metabolism, undoubtedly some- 
what conj ectural as to its finer details. For a good account 
of brine baths, their action and employment, I would 
refer to an article by Keller. 2 Anything like routine 
treatment is apt to be harmful, and the exact procedure 
must be left to an experienced resident physician. 

A bath of this sort is readily prepared; still, there has 
been no attempt made to introduce this treatment in our 
country; experience is altogether lacking on this side 
of the Atlantic, although we possess an ideal locality for 
carrying it out at the popular resorts near Salt Lake City, 

1 The ocean contains 3.5 per cent, of salts, the Baltic Sea 0.7, the 
Great Salt Lake 22.0; the waters of Kreuznach (near Bingen) con- 
tain 1 .3, of Reichenhall (Bavaria) 23.0 per cent. See page 196. 

2 Correspondenzblatt fur schweizer Aerzte, 1891, No. 8. 









SCROFULOSIS AND TUBERCULOSIS. 361 

where the climate also is eminently suitable during the 
greater part of the year. It has been suggested that the 
employment of natural brines is preferable to artificial 
salt solutions, and that much of the effectiveness of the 
former is due to the radioactivity of certain ingredients. 
This statement still requires confirmation, before it can 
be accepted as a definite fact. 

Reports from inland resorts are somewhat less numer- 
ous than those from the seashore, but almost equally 
favorable. Hurlimann 1 shows that a majority of the 
cases are cured in an average of six months at ^Egeri, 
near Zurich, the reports collected by Mouti, 2 relating to 
the' treatment with saline baths are still more glowing, 
and rival those from the seashore. Practically all the 
very scanty American reports refer to inland stations 
at moderate altitudes, but they amount to little numer- 
ically and cannot be successfully utilized for purposes of 
scientific demonstration. Bergougnian 3 speaks highly 
of Evian-les-Bains, on the Lake of Geneva, and the 
other French observers do not dissent entirety, though 
they consider their exceptionally good seashore climate 
preferable. 

The vast similar area in New York and New England, 
as well as in the higher southern Alleghanies, is surely 
calling for similar endeavors on the part of our pedia- 
tricians; in this country .the advantage of the seashore 
over a large number of available inland resorts, at 
moderate elevations, is less evident than in France. 



1 XVII Jahresbericht der Ziircherschen Heilstatte bei ^Egeri, 
etc., Zurich, 1902. 

2 Die Kinderheilkunde in Einzeldarstellungen, Heft 8. Berlin 
and Vienna, 1889. 

3 Loc. cit. 



362 THE CLIMATIC TREATMENT OF CHILDREN 

As to the higher altitudes, I think that we must agree 
with Cornet 1 in reserving them for so-called after-cures. 
An exception may be made to the extent of sending 
older children, whose general condition is tolerably ro- 
bust, to Colorado or New Mexico, where the winter has 
but few intensely cold or stormy days, and there is little 
snow. Cornet's remarks refer to the higher Alps, where 
the winter is certainly too severe for delicate children, 
and the summer is also rather cold. The mere elevation 
is not a very serious objection, though not to be dis- 
regarded by any means. 

To expose an enfeebled child to the winter climate of 
the Adirondacks is often nothing less than cruelty; the 
little patient is likely to suffer intensely from the severe 
cold, and the high ratio of cloudy and stormy days also 
acts as a depressant. The methods worked out in treat- 
ing tuberculous adults cannot be safely applied to 
scrofulous children; now and then, however, an older 
patient, in or near the teens, may- do well in a rather 
rough climate, especially if a generally good condition 
be associated with purely glandular involvement, par- 
ticularly of the very chronic pyogenic type. 

TUBERCULOSIS 

Many volumes could easily be filled with the literature 
on the medical climatology of tuberculosis; one might 
fancy that the specific for this, the most destructive of 
all chronic diseases, had been discovered. The trend of 
thought, however, that characterizes the communica- 
tions flooding medical journalism in these latter days 
shows clearly that a reaction has set in; the authorities 
1 Op. cit. 









SCROFULOSIS AND TUBERCULOSIS 363 

are beginning to doubt if any particular climate is of 
superior value in the management of this affection; one 
might almost fancy that the experience of decades had 
been resting on a delusion. 

This embarrassing situation, of recent development, 
is the result of a fallacious course of reasoning, not very 
difficult to account for. Some years ago, it was the 
general opinion that the victim of tuberculosis, at least 
in its earlier stages, should seek the coldest and roughest 
climate obtainable, so as to be hardened as expeditiously 
as possible, and enabled to check the progress of the 
disease by an increase of his resisting power. When 
patients treated in milder regions were found to do just 
about as well, it was hastily argued that the element of 
temperature was not so very important after all; simi- 
larly, the excellent results achieved in our moist eastern 
mountains, almost equaling those obtained in the 
extremely dry climate of Colorado, seemed to relegate 
the matter of the relative humidity to the background, 
though a lame effort is still being made to class our 
eastern hill climate, as well as that of- the Alps, as dry, 
to save an exploded theory. We are naturally led to 
ask if such a thing as a climatic phthisiotherapy really 
exists. 

The answer is best furnished with the aid of an 
historical retrospect. In the middle of the nineteenth 
century it was still good practice to send tuberculous sub- 
jects to the warmest possible climate, Florida, Madeira, 
and Sicily being favorites, great value being also attrib- 
uted to the West Indian Islands. Those were the days 
of the " neglected cold" theory of phthisis, the obvi- 
ous logical antidote to cold being warmth. From our 



364 THE CLIMATIC TREATMENT OF CHILDREN 

present knowledge of the perils of enervation we readily 
see why these unfortunates usually succumbed rapidly, in 
such numbers, indeed, as to make the reaction inevitable. 
Attempts in the opposite direction, made in our western 
deserts and plains, also in the higher and more lonely 
Alpine valleys, yielded results that by comparison were 
nothing less than brilliant; medical opinion then ran to 
the other extreme, cold and dryness were deemed to be 
the essentials, though as a matter of fact the high Alpine 
climate is rather moist; such inclement regions as the 
far Northwest and the Adirondack Mountains came into 
vogue. When, however, reports from milder regions, 
some indeed semi-southern, showed similarly good re- 
sults, the essential element of a' successful phthisio-ther- 
apy was decided to be merely a sound system of general 
hygiene. Here the matter seems to rest at this date, at 
least in the opinion of very many. 

It is not a difficult matter to prove that this point of 
view is mistaken. In the first place, the sanatoria in 
mild regions, such as the vicinity of New York City, do 
not benefit their patients much during the summer 
months, when the mean temperature exceeds 68 to 70 
degrees. Secondly, we begin to hear complaints from 
southern California of the general infection of a previously 
immune population with tuberculosis, which would be 
impossible were that climate really very unfavorable to 
the progress of this disease. The specialists have now 
agreed that southern California is too warm for the best 
results, and reserve this region for enfeebled and ad- 
vanced cases, who would often do better to stay at home. 
Thirdly, we need merely repeat the old untoward ex- 
periences in the truly subtropical climates. It is plain, 



SCROFULOSIS AXD TUBERCULOSIS r 365 

therefore, that warm weather and warm climates are not 
salutary to tuberculous patients, the reason, as before 
stated, being the rather rapid development of enervation 
and a lowered resistance, the early stages of which prob- 
ably existed at the onset of the disease and invited its 
invasion. 

On the other hand, intense cold is not a necessary 
therapeutic factor. There is indeed that type of winter 
weather, with a mean temperature near the freezing 
point, which in a moist climate involves frequent al- 
ternations of snow, sleet, frost, thaw, and rain, with a 
general average of sloppiness and muddiness, and is ob- 
jectionable on account of its interference with outdoor 
exercise and a tendency to fogs. TYhen, however, the 
temperature keeps well above or below that point most 
of the winter, also when the amount of precipitation is 
small, the stated objections do not obtain. The intense 
cold of the far Xorth or at high elevations is depressing to 
all but the robust ; during the prevalence of temperatures 
below zero careful attention is needed to keep the pa- 
tients comfortably warm; in the case of children, who 
nearly always lack the prerequisite of robustness, the 
very cold climates are to be recommended only in excep- 
tional cases. Thus we have a difference between the 
respective management of children and adults, winch 
at a first glance appears fundamental, yet is not so in 
reality, for the treatment that might well be called sub- 
arctic is now well known not to be essential, as it repre- 
sents an extreme attitude. Judicious hardening is as 
important in the treatment of tuberculosis in children 
as in adults: we have seen what limitations must be 
applied to a scheme of hardening in young subjects, but 



366 THE CLIMATIC TREATMENT OF CHILDREN 

the general principle remains the same for them as for 
older persons. 

The polymorphism of tuberculosis in children, as com- 
pared with the overwhelming preponderance of local- 
ized pulmonary involvement after puberty, has already 
been referred to. The adult lesion is very rarely, if at all, 
foimd by itself in infants, who are so susceptible to the 
ravages of the tubercle bacillus that the infection in 
them has a disastrous tendency to become generalized 
and assume the rapidly fatal miliary type. After the 
age of three or four years there is a greater tendency to 
localization, but here also conditions differ from those in 
later life, in that the bones and serous 'membranes are 
far more apt to suffer than the viscera; there is also a 
decided predilection for the extensive or even universal 
lymphatic involvement which has been discussed under 
the heading of scrofulosis. During the years of school 
life, however, the transition to the adult types of tuber- 
culosis becomes increasingly manifest, so that by the 
twelfth year the ordinary pulmonary lesions become 
quite frequent, though their course still tends to be 
rapidly progressive. Thus tuberculosis in childhood is 
in every way a matter apart from the phases of this 
infection as ordinarily understood. 

It is plain that we can dispose of our subject to greater 
advantage, and derive more satisfaction from its study, 
if we divide the entire field, aside from such mild forms 
as have already been discussed under the heading of 
scrofulosis, into the two divisions of surgical and visceral 
tuberculosis, and pay separate attention to the climatic 
management of each. 

Surgical Tuberculosis. The majority of tuberculous 



SCROFULOSIS AND TUBERCULOSIS 367 

children, especially between the ages of four and twelve 
years, belong to this group. Their treatment closely 
follows that outlined for those afflicted with scrofulosis, 
so that authors like Cornet consider them under the same 
title, and draw no dividing line between them. For our 
purposes also, it will not be necessary to repeat what was 
dealt with at length in the preceding paragraphs; we 
are here called upon to refer only to certain details re- 
garding procedure and results. 

To begin with, a sufficient duration of the treatment of 
surgical tuberculosis cannot be urged too strongly; we 
have already noted the weak point of the German sana- 
toria in this regard, and can readily see why Keller 1 says 
that the results are only fairly good. At the Asyle 
Dollfus at Cannes children have been kept for eight 
months, and at other French sanatoria a year or more. 
Thirty per cent, of cures is not an exceptionally good 
result under these circumstances, some stations claiming 
twice as high a ratio. Larsen, 2 for the rather raw cli- 
'mate of Frederiksvarn, Norway (mean February tem- 
perature 28 degrees), reports 72 per cent, of cures 
after an average stay of ten months. Gevaert 3 re- 
ports good results from Middelkerke, near Ostende, as 
the effect of an average treatment of eight months' 
duration; the winter climate there being not much 
warmer than at Cape May. As to milder climates, we 
obtain a most optimistic report from Haudek 4 who re- 
cords excellent results from Abbazia, on the Adriatic, 
where the climate is little better than at the entrance of 

1 Monatsschrift fiir Kinderheilkunde, October, 1903. 

2 Norsk Magazin for Laegevidenskaben, 1901. 
8 Journal medical de Bruxelles, 1902, No. 10. 
4 Wiener medizinische Presse, 1904, No. 46. 



368 THE CLIMATIC TREATMENT OF CHILDREN 

Chesapeake Bay; he also insists on a stay of a year or 
more, if the case seems to demand it. Older reports 
have been collected by Monti, 1 Brauer, 2 and Uffelmann, 3 
reaching back to 1865. 

In view of the above mass of statistics, embracing in 
all no less than twenty-one sanatoria, with the omission 
of a still greater number, the allowance of a few weeks 
in summer at our sanatoria for children can be regarded 
only as a wretched apology for treatment. The patients 
cannot possibly derive any permanent benefit from such 
a makeshift ; they may pick up a little under the influence 
of the purer air and better food, but are usually returned 
to the tenements before the summer is over, and are 
almost certain to relapse into their original state within 
a very short time. It is therefore pleasing to note that 
an attempt has at last been made to establish a winter 
sanatorium for children in this country. The beginning 
was made at Coney Island in the winter of 1904-5, and 
the municipality of New York is apparently making an 
earnest effort to take up this subject seriously and with 
a true appreciation of its vastness. Brannan 4 has re- 
ported concerning this first experiment at Coney Island, 
on a very small scale, which was an achievement of 
private philanthropy; 5 unfortunately, the winter was 
exceptionally cold, averaging 27 degrees instead of the 
normal 32, and the results obtained were only fairly 
good. This was possibly due in part to the excessive 
amount of snow, and to the prevalence of high and 
intensely cold northwest winds, but much may also be 

1 Op. tit. 2 Dissertation, Berlin, 1886. 

8 Archiv fur Kinderheilkunde, 1881, vol. 2. 

4 Medical News, November 11, 1905. 

5 Adequately endowed on June 30, 1906. 






SCROFULOSIS AND TUBERCULOSIS 369 

set down to the shortness of the course of treatment, 
the defect adversely commented on in connection with 
the German sanatoria. It remains an open question, 
whether the climate of the coast near New York is not a 
little too cold and exposed for the best results, and the 
unusually mild and sunny winter of 1905-6 (average 
temperature 36 degrees) will not tend to clear the situa- 
tion, for the next report is certain to be better, under 
such exceptionally good meteorological conditions. The 
Long Island coast has, however, the incontestable advan- 
tage of abundant sunshine in winter, in which the re- 
sorts of western Europe are deficient, and in particular 
a highly salubrious climate in the autumn months. The 
spring is rather changeable, and the summer often so 
sultry that it is doubtful if this region is really very 
beneficial in surgical tuberculosis during July and 
August. At any rate, repeated trial is urgently called 
for before giving up so promising a project, which has a 
half century of European experience to back it. The 
attempt to found a sanatorium farther south would 
entail heavy additional expense, besides involving an 
almost insoluble question of jurisdiction in case of an 
official or semi-official enterprise. Moreover, the hostil- 
ity to sanatoria for tuberculosis is at present growing 
apace, knowing neither reason nor common humanity, 
and cannot be ignored by the state authorities, even if 
the legal difficulties prove quite surmountable. 

The older physicians made a distinction between the 
erethitic and torpid types of scrofulosis and tuberculosis, 
which has some relation to climatic treatment. The 
erethitic type comprises " delicate" looking children, 
slender in build, with an almost transparent skin, poor 



370 THE CLIMATIC TREATMENT OF CHILDREN 

.development of adipose and muscular tissue, and a 
neurotic temperament; the torpid type includes heavily 
built, often quite stout and active children, of a phleg- 
matic temperament. It is evident, of course, that these 
groups represent respectively opposite degrees of sus- 
ceptibility to, or virulence of, the tuberculous infection; 
naturally, also, a very large proportion of our young 
patients will occupy an intermediate and perhaps inde- 
terminable position. Often every factor in each case 
will have to be carefully weighed, if the most appropriate 
treatment is to be inaugurated. 

The main point is that torpid cases may at once be 
submitted to a plan of hardening at cool seaside or moun- 
tain resorts, whereas this method is very apt to injure 
the severer erethitic cases at the outset. Perier, 1 who 
recommends the seashore whenever possible, urges the re- 
moval of the latter patients to a fairly warm inland resort, 
at least to begin with ; the colder climates are probably 
best avoided altogether, except as an after-cure. An 
element that we must not disregard in the manage- 
ment of these children is the harmf illness of too much 
physical exercise, but when a rather sedentary life 
is to be led, a mild temperature becomes absolutely 
necessary, if the child is to spend most of the day in 
the open air. 

The torpid type of surgical tuberculosis is one of 

the few conditions in which we can recommend a sea 

voyage; Weber, 2 Williams, 3 and Doyle 4 speak highly of 

this procedure, and furnish good evidence of its efficacy. 

The main thing is that a tour of ample duration, like the 

1 Loc. cit. 2 Loc. cit. . 

3 Edinburgh Medical Journal, March > 1905. 

* Lancet, 1890, vol. 2. 



SCROFULOSIS AND TUBERCULOSIS 371 

popular one to the Mediterranean, be chosen, and that 
the child be under really good and intelligent manage- 
ment; in that event considerable improvement may be 
looked for; cruises in the tropics or in notoriously stormy 
seas are, of course, entirely barred. On the trip I have 
mentioned there is usually the rare advantage of really 
competent medical attendance, which I consider quite 
indispensable. 

We have previously referred to the radical change 
in the management of tuberculous cases that must be 
adopted if a renal complication or amyloidosis super- 
venes, and may refer back to those pages. The immedi- 
ate cessation of every attempt at hardening is of course 
not favorable to the eradication of the tuberculous pro- 
cess, but we are, most unfortunately, reduced to a choice 
between two evils, when either of these complications 
turns up, and the underlying affection, while sufficiently 
serious, is the one less liable to run a rapidly unfavorable 
course under inferior climatic conditions. 

Such cases as are debarred from exercise by the locali- 
zation of the tuberculous process in the lower extremities 
may require a slightly warmer climate in winter than 
the others; these patients were, for example, those that 
showed relatively slight improvement at Coney Island. 
Sitting in the sun on a very cold day is possible only with 
perfect shelter from the wind, and the sun is, of course, 
on the windward (west) side of the sanatorium in the 
afternoon on our most blustering days; thus a certain 
proportion of the opportunities for outdoor life is bound 
to be lost 

Visceral Tuberculosis. Visceral tuberculosis in the 
adult signifies; for all purposes, pulmonary tuberculosis 



372 THE CLIMATIC TREATMENT OF CHILDREN 

with possibly secondary implication of other organs, such 
cases forming perhaps 99 per cent, of the total. In chil- 
dren the pulmonary lesion is less predominant, particu- 
larly in the earlier periods of life; during the school age 
pathological conditions tend more and more to approach 
those in the adult, so that, at puberty, there is no radical 
difference from the conditions in later years. In early 
childhood, visceral tuberculosis has a great tendency to 
assume the miliary type and become generalized; we 
therefore rarely have to deal with an isolated affection 
of a limited area of the lung; intestinal tuberculosis is 
possibly quite as common, and the occurrence of menin- 
geal complications is frequent. It is not practicable to 
regard any case in a young child as incipient, as may 
often be done in older subjects with perfect safety; we 
shall do better by our young patients, if we consider 
every positively diagnosticated case as advanced, for 
there is almost surely more extensive visceral and glandu- 
lar involvement than is accessible to our diagnostic 
methods, and the chances for a rapid spread or miliary 
generalization are much greater. To state the matter 
concisely, pulmonary tuberculosis in the young child 
is usually not a local affection, but only part of a more 
or less general systemic invasion by the tubercle ba- 
cillus. 

The above considerations have a vital bearing on the 
subject of climatic treatment; to the previously stated 
objections to sending young children to severe climates 
we have added the circumstance that the individual case 
is usually past the stage for such removal. The prog- 
nosis of these cases is, in fact, far worse than the statis- 
tics compiled from adult material would suggest; in the 



SCROFULOSIS AND TUBERCULOSIS 373 

first few years of life it is practically fatal, and even at 
puberty far worse than in the twenties and thirties, 
partly for the reasons mentioned, partly from the feebler 
general resisting power, partly because of the objections 
to entering upon a severe hardening regimen. 

It may not be superfluous to mention the essential 
requirements of a good resort for the treatment of pul- 
monary tuberculosis; there are few matters on which 
the medical world is so generally in accord. In the first 
place, there must be ample wind shelter and freedom 
from dust; the former is obtained by the selection of a 
well-forested region and a hillside with a leeward expos- 
ure, which is easterly and southerly in our latitudes, as 
our worst winds come from the northwest; the latter is 
secured by fairly frequent and moderate rains in summer 
and a covering of snow in winter. Secondly, good food, 
perfect general sanitation, and ample facilities in the way 
of intelligent medical attendance and nursing, are equally 
important; the satisfactory combination of these require- 
ments is hardly obtainable in this country outside the 
better grade of sanatoria, whereas they can be secured 
by the ordinary visitor at dozens of European resorts. 
Thirdly, the tuberculous patient requires good roads and 
paths for short walks, with abundant seats and benches, 
the latter to be placed as advantageously, as possible; 
here also everything has been done in Europe, nothing at 
American resorts, with but few exceptions. Fourthly 
comes the matter of accessibility ; this is important only 
for the poorer classes, as the modern means of travel 
are rarely very trying to any save advanced cases; the 
item of expense is the main consideration in this re- 
gard. Fifthly comes the matter of temperature, which 



374 THE CLIMATIC TREATMENT OF CHILDREN 

is also the easiest to dispose of, for the limits are arctic 
cold (for children) on the one hand, and enervating 
warmth on the other, the second being an objection at 
all ages; this last subject has already received a good 
deal of attention in this manual, and requires only a few 
additional remarks, to follow. 

We must again repeat that, with the exception of 
children near the age of puberty, the very cold climates 
are absolutely barred' from consideration. 1 The best 
resorts are similar to those recommended for the merely 
scrofulous, when the progress of the disease is slow, and 
there is relatively little pus formation. The actively 
catarrhal cases must be referred to inland resorts, which 
can hardly be too dry. Arizona and the warmer parts 
of New Mexico are none too arid for cases with free 
expectoration, provided that there is no laryngeal in- 
volvement, and the febrile movement is not severe; 
Egypt is inferior for our purpose, as it can be utilized 
only during the winter, and thus renders long voyages 
necessary and frequent. Weber 2 recommends these 
climates particularly for cases with albuminuria; our 
discussion of that symptom on preceding pages quite 
accords with this view. The main objection to the semi- 
desert regions is the dust; for the cases here spoken of 
a little aseptic dust is less harmful than a high humidity. 
The great advantage of the American desert region is the 
feasibility of removal to the cooler mountain regions of 
the West, during the summer; these patients do not 
suffer at high elevations during the warm weather, even 
if somewhat asthmatic (Weber). 

1 See, however, Morse, N. Y. Med. Journal, Dec. 1, 1906. 
2 3Loc. cit, 



SCROFULOSIS AND TUBERCULOSIS 375 

Such warm and moderately moist resorts as the 
Riviera and southern California in winter, and the Middle 
Atlantic Coast and the Lake Region in summer, are 
tolerably well suited to the more enfeebled cases, such 
as have laryngeal symptoms more particularly; but in 
general it is wiser to send these patients somewhat inland 
in the warm season. In our discussions on climatology 
we noted that the seaside is drier than the hinterland in 
winter and moister in summer; it is wise for the less 
well-informed to study the humidity tables with some 
care, and avoid places with figures over 75 per cent. In 
winter, the colder seashore stations, including those of 
western Europe more particularly, have proved failures 
in the phthisis of children, and the same will be found, 
upon further investigation, to be true in this country 
north of the 38th parallel. 

C. T. Williams 1 says that cases with extensive cavities, 
fibrosis, severe pyrexia, complicated visceral involve- 
ment, and previous degenerations due to residence in 
warm climates (enervation), do badly in the mountains; 
the French and German observers, already quoted, say 
that they do badly at the seaside. As a matter of fact, 
they are apt to go from bad to worse anywhere and 
everywhere, but an attempt should be made to arrest the 
progress of the infection at mild inland resorts, such as 
the southern slope of the Alps and the Alleghanies; in 
the latter it is, of course, understood that some such 
alternation as North Carolina in winter, and New York 
in -summer, be carried out. More enervating climates 
accomplish no permanent good; the patient may feel 
more comfortable imder their influence, but makes no 
1 The Practitioner, June, 1898. 



376 THE CLIMATIC TREATMENT OF CHILDREN 

real progress; the far southern winter resorts should be 
reserved for hopeless cases, whom it is still kinder to 
keep at home, if the surroundings there are fairly good. 

Some of these courses of treatment involve a journey 
of several days or a voyage lasting a week or two; we 
may therefore glance at the contraindications to pro- 
longed travel. Nothnagel 1 thinks that moderate fever 
does not contraindicate travel; in fact, the temperature 
often falls and remains normal shortly after arrival. I 
would not hesitate to send patients with typical hectic 
fever a comparatively short distance, say 500 or even 
1,000 miles, if conditions at home are so unpromising as 
to lend no prospect of amelioration without removal. 
Severe diarrhoea, according to Cornet 2 and others, con- 
traindicates travel, which is both difficult and exhaust- 
ing under such circumstances; this objection does not, 
of course, apply to a short ride on a first-class railway, 
•such as the four hours' journey from New York City to 
Liberty, N. Y. 

The ordinary pulmonary cases, with or without com- 
plications, that affect older children similarly to adults, 
may now be treated at a number of sanatoria in this 
country devoted primarily to older persons. These 
cases are not so numerous as to require the establishment 
of separate institutions; the results of treatment are 
similar to those in adults, when the cases are really 
incipient. As before stated, this point is ascertained 
with greater difficulty in children than in adults, and 
we know full well that a too optimistic diagnosis and 
prognosis is common enough at the latter period of life. 

1 Allgemeine Wiener Medizinalzeitung, 1885. 

2 Nothnagel, specielle Pathologie u. Therapie, vol. 14, part 2 b. 



SCROFULOSIS AND TUBERCULOSIS 377 

The strenuous hardening measures that, often prove 
extremely valuable in fairly robust men and women are, 
of course, not to, be carried out in young subjects to. 
anything like the same degree; otherwise the treatment 
need not be varied essentially because of the patient's 
age; enervation is equally bad for both groups. 

Turning now from those cases in which the pulmonary 
lesion is uncomplicated or predominant to the other 
phases of visceral tuberculosis, we are confronted with a 
most trying problem. Meningitis is practically a hope- 
less affair, but renal tuberculosis is occasionally amen- 
able to climatic measures, when unilateral; 1 pleurisy is 
almost always secondary to a pulmonary lesion, and does 
not usually impair its prognosis to a very serious degree. 
As to tuberculous peritonitis, which is an affection almost 
peculiar to childhood, we are in less of a quandary than 
the surgeons, who have a most puzzling operative indica- 
tion to deal with; the climatic treatment recommended 
for scrofulosis and .surgical tuberculosis is absolutely 
indicated in these cases, and will certainly yield a fair 
proportion of good results in this far from hopeless 
affection. As an after-cure to surgical measures, the 
removal to a favorable climate is even more important, 
but in such an event it would be well to begin with a 
rather mild resort, until the patient recovers a certain 
measure of strength; then moderate hardening becomes 
decidedly the order of the day. 

SANATORIA 

This is perhaps the most appropriate place for the 
introduction of a few remarks on sanatoria for scrofulous 
1 See Morse, loc. cit. 



378 THE CLIMATIC TREATMENT OF CHILDREN 

and tuberculous children. As climate and location have 
been dwelt on in ample detail, this space may be devoted 
to less obvious matters. Architecturally, there can be 
no doubt that the one-story cottage plan answers all 
purposes best. The cottages may be built of timber or 
iron, with an attic for purposes of storage and to keep 
the main floor cool in summer, but not for occupancy; 
the entire structure should be elevated a foot or two, 
to guard against dampness and flooding during cloud- 
bursts or from the melting of snow, and the floor should 
be waterproof. The sides should form practically one 
great window, the upper portions being constructed in 
such a fashion as to permit opening at the top alone in 
cold weather. An ample covered and partly enclosed 
porch should be built on the eastern or southern front, 
but I do not regard a solarium as very important. 

The maximum number of patients to each cottage 
should be twenty. This permits the classification of 
patients as to age and type of disease, and also allows the 
treatment of non-tuberculous children under the same 
management; thus a cottage might be devoted exclu- 
sively to rhachitis, another to chronic bronchial affec- 
tions, and so on, for the cottage plan is not greatly 
limited as to size; it is easy to group eight of these small 
structures around a central administration building, 
though the E-shaped plan is in some ways preferable. 

Communication with the central building may be by 
covered and enclosed passageways; food may thus be 
more readily transported to the cottages without becom- 
ing cold, and the plan also has advantages for the at- 
tending staff in bad weather. The staff, when off duty, 
must be furnished with quarters in the administration 



SCROFULOSIS AND TUBERCULOSIS 379 

building, else lamentable institutional infections are 
likely to ensue. The entire institution should be heated 
by steam supplied from the main building, and all save 
minor surgical procedures should also be carried out 
there. 

Visitors should be excluded' entirely if possible, other- 
wise epidemics of measles and scarlatina will be of fre- 
quent occurrence. To provide for such acute infections 
as are bound to break out, with the best of care, a sepa- 
rate cottage, with a separate small kitchen, should stand 
quite distinct from the rest of the institution. There 
must be no communication by covered passages, and the 
attending and working staffs should be distinct. The 
pathological department is also to be maintained in a 
distinct building, preferably also without direct com- 
munication. 

Ample playgrounds are a necessity ; also, at the seaside, 
facilities for bathing. Our hot summers demand the 
erection of tents for sojourn during the day, so that 
exposure to excessive insolation may be avoided. Dense 
woods are objectionable because of dampness, but an 
open grove, especially of coniferous trees, answers very 
well as a substitute for tents, and allows the children 
more freedom. We may here state that anything like 
crowding or cramping of the institution or its surround- 
ings is a grave error; a half acre to each building, as 
much more for outside space, and twice as much more 
for playgrounds, bathing beaches and the like, is none 
too much; thus a sanatorium with eight " effective" 
cottages requires a minimum space of about twenty 
acres, one to eight patients. 

There should be no fixed limit set for the duration of 



380 THE CLIMATIC TREATMENT OF CHILDREN 

treatment, save that three months may be regarded as 
the minimum. Accommodations should be sufficient 
to allow slowly progressive cases a year or more, and the 
number returned home " improved" should be as small 
as possible, for these children regularly relapse. It is a 
serious mistake for an institution devoted to the treat- 
ment of tuberculosis to include " improved" cases among 
its successes; the lay public is already observing the 
frequency of recurrence in this group, and becoming 
skeptical as to the merits of sanatorium treatment. The 
German custom of returning every patient home within 
a definite time, usually three months, will eventually 
bring the entire system into discredit; a year is none 
too long for the cure of any well-developed tuberculous 
lesion. 

There is much less difficulty in maintaining good 
institutional discipline with children than with adults; 
it is indeed remarkable how rapidly children become 
accustomed to the surroundings of a well-managed sana- 
torium. Home means very much less to them than 
their parents fondly imagine, and there is no trouble, in 
keeping the little patients in good spirits after the first 
few days. Nostalgia, which leads so many adults to 
quit the sanatorium before much benefit has been 
achieved, is not an element to be weighed in the young; 
on the other hand, the importunities of parents for the 
return of their half-cured children is a serious obstacle 
to the highest efficiency of a sanatorium, and calls for all 
the tact and patience at the disposal of the manage- 
ment, if it is to be effectively counteracted. Laxity 
in this respect will assuredly impair the record and 
reputation of the institution; imperfect results may 



SCROFULOSIS AND TUBERCULOSIS 381 

confidently be reckoned among the failures, only actual 
and permanent cures redound to its credit among the 
public at large. 

Thus, the problems that confront the management 
of a sanatorium for scrofulous and tuberculous chil- 
dren are manifold, and at least as much sociological as 
medical. 



GENERAL BIBLIOGRAPHY 

American Summer Resorts, Medical Record, June 13, 1896. 

American Winter Resorts, Medical Record, October 31, 1896. 

Baedeker. Canada. 

Baedeker. The United States. 

Baginsky. Die Bedeutung der Seehospize fur die Behandlung der 
Skrophulose, Berlin, 1903. 

Canada, Dominion of, Meteorological Service, Annual Reports and 
Monthly Weather Review. 

Crook. Some Topographical and Climatic Features of the Florida 
Peninsula, Medical News, January 26, 1901. 

Davidson. Notes on the Health Resorts of Southern California, 
British Medical Journal, January, 1893. 

Dettweiler. Die Therapie der Phthisis, Wiesbaden, 1887. 

Freudenthal. The Climatic Influence of our Southwestern States, 
etc., New York Medical Journal, March 26, 1898. 

Greeley. American Weather, New York, 1889. 

Hann. Handbuch der Meteorologie, Stuttgart, 1897. (First part 
also in English translation.) 

Hann. Lehrbuch der Klimatologie, Leipzig, 1901. 

Hare. Text-book of Practical Therapeutics, 11th edition, Phila- 
delphia, 1906. 

Henoch. Vorlesungen iiber Kinderkrankheiten, 11th edition, Ber- 
lin, 1903. 

Hinsdale. Climates and Health Resorts in the Dominion of Canada, 
Journal of Balneology and Climatology, October, 1903. 

Hirsch. Handbuch der historisch-geographischen Pathologie, Stutt- 
gart, 1881. 

Hochsinger. Die Gesundheitspflege des Kindes im Elternhause, 
Leipzig, 1896. 

Holt. The Diseases of Infancy and Childhood, 3d edition, New 
York, 1906. 

Koplik. The Diseases of Infancy and Childhood, 2d edition, Phila- 
delphia, 1906. 

383 



384 THE CLIMATIC TREATMENT OF CHILDREN 

Knight. The Climates of New England, International Medical Mag- 
azine, July, 1897. 

Landois. Physiologie des Menschen, Berlin, 1900. (Also in English 
translation.) 

Loewy. Die Wirkung der Hohen- und Seeklimas auf den Menschen, 
Deutsche medizinische Wochenschrift, January 21, 1904. 

Manson. Tropical Diseases, London, 1904. 

New York Department of Health, Reports. 

Osier. Practice of Medicine, 6th edition, New York, 1905. 

Perry. Some Observations on the Occurrence of Malarial Fevers on 
the Pacific Coast, New York Medical Journal, December 3, 1898. 

Powell. Sea-air and Sea-bathing in Convalescence, American Text- 
book of the Diseases of Children, Philadelphia, 1894. 

Solly. Medical Climatology, Philadelphia, 1897. 

Strasser. Erkaltungund Abhartung, Deutsche Klinik, Volume 1, 1905. 

U. S. Census Report, 1900, Volume 3, Vital Statistics. 

U. S. Department of Agriculture, Weather Bureau, Reports and 
Papers. 

U. S. War Department, Signal Service (to 1891). Reports and 
Papers. (Also reports from corresponding departments of 
various states.) 

Van Dyke. Southern California, New York, 1886. 

Verrill. The Bermuda Islands, New York, 1903. 

Weber and Foster. Climate in the Treatment of Disease, Allbutt's 
System of Medicine, Volume 1, London, 1896. 

Weber and Hinsdale. Climatology, Health Resorts and Mineral 
Springs; Solis-Cohen, a System of Physiologic Therapeutics, 
Volumes 3 and 4, Philadelphia, 1902. 

Yeo. The Therapeutics of Mineral Springs and Climates, Chicago, 
1904. 



LIST OF AUTHORS 



Affanassiew, 225. 
Anders, 18. 
Avellis, 310. 

Babcock, 327. 
Bergougnian, 340, 361. 
Bowditch, 256. 
Brannan, 368. 
Brauer, 368. 
Brit ton and Brown, 48. 
Brown, S., 338. 
Bunsen and Roscoe, 28. 
Burckhardt, 279. 
Biirgi, 26. 

Chvostek, 279. 
Cornet, 354, 362, 376. 
Crombie, 344. 

Danziger, 326. 

D'Espine, 356, 357. 

Determann, 260, 270, 327, 338. 

Donath, 279. 

Downes and Blunt, 219. 

Doyle, 370. 

Dunbar, 48. 

Edel, 293, 294. 
Eolwards, 291. 
Egger, 24, 27. 
Erb, 204. 

Fischl, 321. 
Freudenthal, 215. 

Galli, 327. 
Gevaert, 367. 
Gottstein, 24. 
Grawitz, 24. 
Grebner, 356. 
Greeley, 86. 
Guhr, 352. 



Hann, 4, 44, 61, 139, 186. 

Hansemann, 263. 

Harrington, 14. 

Haudek, 367. 

Hecker, 231-235, 339. 

Henoch, 312. 

Hirsch, 44, 296. 

Hochsinger, 230. 

Hoessli, 273. 

Hoffmann, 3. 310. 

Holt, 221, 256, 312, 316, 320, 344. 

Homberger, 279. 

Howard, 45, 47. 

Huchard, 270. 

Hurlimann, 361. 

Ide, 261, 339. 

v. Jaksch, 269 
Jilek, 46. 

Keller, 310, 360, 367. 
Kisskalt, 228. 
Koppen, 33. 
Koerner, 326. 
Koplik, 355. 
KrafTt-Ebing, 338. 
Kundig, 25. 

Langley, 28. 
Larsen, 367. 
Lassar, 225. 
Lazarus, 269. 
Lode, 227. 

MacFarlane, 345, 346. 
Mendel, 349. 
Mitchell, Weir, 349. 
Monti, 361, 368. 
Morse, 269, 374, 377. 

Nebelthau, 226. 
v. Noorden, 269. 



385 



386 



THE CLIMATIC TREATMENT OF CHILDREN 



Northrup, 340. 
Nothnagel, 376. 

Osier, 280, 312. 

Pasteur, 227. 

Pearce, 260, 338, 346. 

Perier, 291, 310, 339, 357, 370. 

Porter, 256, 257. 

Powell, 261, 321. 

Quetelet, 256, 257. 

Rem-Picci, 287. 
Robin, 261. 
Robin and Binet, 357. 
Rode, 310, 356. 
Rosenthal, 225. 
Ruhemann, 18. 

Saake, 28. 
Seibert, 41, 43. . 
Senator, 288. 
Sohon, 139. 



Solly, 313. 
Szego, 321. 

Thierfelder and Giinther, 43. 

Uffelmann, 368. 

Viault, 23. 
Vierordt, H., 331. 
Vincent, 15. 

Wachenheim, 43. 

Weber, 197, 198, 270, 370, 374. 

Weber and Foster, 310, 357. 

Weinzirl, 26. 

Whymper, 27. 

Williams, C. T., 375. 

Williams, L., 290, 370. 

Wolff and Koeppe, 24. 

Wyman, 322. 

Wood, 355. 

Yeo, 260, 277, 279. 

Zillessen, 226. 



INDEX 



Heavy face type refers to numerical data. Localities will be found 
under their respective states. 



Acclimatization, 5, 23, 343. 

Adenoid hypertrophy, 315; and bronchitis, 308; and hardening, 
231; and hot-air furnace, 215; and malnutrition, 256; and 
- scrofulosis, 315, 355. 

Africa, pneumonia in 44; sleeping sickness in, 47. 

Alabama, cloudiness and humidity, 108; precipiation, 126-129; 
temperature, 76, 77, 109; Mobile, 76, 77, 109, 155; Mont- 
gomery, 76, 77, 109, 129. 

Alaska, cloudiness, 117; as health resort, 167; precipitation, 137, 
138; temperature, 100, 101; Nome (Port Clarence) , 101; Sitka, 
100, 137; Unalaska, 100, 117. 

Alberta, cloudiness, 113; precipitation, 130; temperature, 85, 114; 
Banff, 85, 160, 275; Edmonton, 85, 114. 

Albuminuria, cyclic and orthostatic, 287-289; etiology, 225, 287 
288; treatment, 289-295, 374; see also Nephritis. 

Algeria, climate, 192, 193; Algiers, 192, 244, 291; Biskra, 192. 

Alleghanies, cloudiness and humidity, 104, 107; as health resort 
(Northern), 239, 247, 249, 283, 294, 302, 304, 323, 340, 359, 
375; (Southern), 245, 247, 260, 280, 294, 311, 323, 328, 340, 
359, 361, 375; precipitation, 124, 127, 128; temperature, 
66-68, 74-76, 105, 107, 247; winds, 60, 154. 

Alps, cloudiness and humidity, 180, 181, 183; as health resort, 240, 
241, 245, 260, 268, 270, 272, 280, 283, 292, 293, 311, 317, 327, 
328, 362-364, 375; precipitation, 180-182; temperature, 179- 
181. 

Ambrosia (ragweed) , 48, 49, 322. 

Amyloidosis, 280-282, 371. 

Anaemia, 269-272. 

Anopheles, 45, 46. 

Arizona, cloudiness and humidity, 116; as health resort, 162, 243, 
274, 291, 374; precipitation, 133-135; temperature, 15, 91-93, 
117; Grand Canon, 162; Phoenix, 91, 92, 116, 117, 133, 134, 
162, 359; Prescott, 91, 92, 162; Tucson, 162, 359; Yuma, 93, 
116, 117, 135, 162. 

Arkansas, cloudiness and humidity, 107; precipitation, 127; tem- 
perature (Little Rock), 75, 107, 108; Hot Springs, 158, 275, 
276. 

Asthma, and bronchitis, 309; treatment, 311-313. 

387 



388 THE CLIMATIC TREATMENT OF CHILDREN 

Atlantic Coast, as health resort, 243, 259, 261, 304, 358; winds, 59, 
60, 79; see also New England, Middle Atlantic Coast, South- 
eastern States. 

Austria-Hungary, health resorts, 196-197; precipitation, 180-182, 
191; temperature, 179-181, 191; winds, 190, 191; Carlsbad 
(Bohemia), 179; Fiume (Abbazia), 191, 367; Ragusa (Dal- 
matia), 191; Riva (Lake Garda), 181, 280; Trieste (Istria), 
191; Tyrol (northern, Innsbruck), 179; (southern, Meran), 
181, 280, 341; (upper), 180; Vienna, 179. 

Autumn, atmospheric pressure and winds, 55; resorts, 248, 249. 

Bacteria, and colds, 228; and moisture, 20; and sunshine, 18, 219. 
Bahamas, climate, 80; as health resort, 280. 

Basin, the Great, see Plateau, the Western; and Rocky Mountains. 
Baths, in childhood, 230, 234; cold, 230, 309, 357; and hardening, 

230; reaction, 204, 235; saline, 196, 278, 283, 295, 330, 360; 

sea, 201-204, 261, 266, 267, 283, 324, 348, 357, 359; sponge, 

234, temperature of, 8, 234. 
Belgium, climate, 174; health resorts, 195; Ostende, 174, 367. 
Bermudas, as health resort, 157, 158, 279, 290; precipitation, 

126-129; temperature, 31, 80. 
Bladder, diseases of, 297, 298. 
Blood cells, at elevations, 24-26; in summer and winter, 26; see 

also Ancemia. 
British Columbia, as health resort, 166, 167; precipitation, 133, 137, 

138; temperature, 89, 99, 100, 119; Barkerville, Mamloops, 

89, 167; New Westminster, 166; Quatsino, 138; Victoria, 99, 

100, 119, 166. 
Bronchiectasis, 309; and pneumonia, 316; treatment, 312, 313, 316, 
Bronchitis, 308-313; and pertussis, 320. 

California, cloudiness and humidity, 116-119; dust, 165, 313; earth- 
quakes, 136; fogs, 98, 118, 163, 164; frost, 97, 98, 163, 164; as 
health resort, 163-165, 237, 243, 247, 248, 259, 267, 274, 278, 
280, 291, 292, 298, 311-313, 329, 332, 359, 364, 395; precipi- 
tation, 135-137; temperature, 31, 42, 93-99, 117, 119; winds, 
58, 60, 96, 163, 164; Death Valley, 93, 116; Eureka, 97, 93, 
118, 119; Farallone Islands, 31, 96; Fresno (San Joaquin 
Valley), 58, 98, 119, 136; Independence, 93, 117; Lake Tahoe 
(Sierra Nevada), 95, 135, 136; Los Angeles, Pasadena, 94, 95, 
117, 163, 243, 248, 280, 359; Monterey, Santa Cruz, 94, 164; 
Mt. Tamalpais (Coast Range), 96, 97; Oakland, San Rafael 
'96, 97, 248, 317; Red Bluff, 58, 98, 117; Riverside, San Bernar- 
dino, 163; Sacramento, 98, 117, 119; Salton (Colorado Desert), 
93, 162; San Diego, 94, 95, 117, 163, 243, 358, 359; San Fran- 
cisco, 42, 96, 97, 117, 164, 304, 358; Santa Barbara, 94, 163, 
267; Santa Catalina Island, 94, 163. 

Canada, as health resort, 242, 246; see also the various provinces. 

Childhood, peculiarities of, 2, 3, 33-40; see also Infancy and Puberty. 

Chlorosis, 254, 269, 272; see also Anosmia. 

Chorea, 277, 346, 347. 



INDEX 389 

Cities, bad effect on children, 36, 252, 299, 336; temperature in, 
62, 300. 

Climate, classification, 32-34, 167-169; disease and, 40-49, 307, 
344; physiology of, 6-32; population and, 5, 6; weather and, 4. 

Climatotherapy, application, 1, 34-40, 204-206; (seasonal), 236- 
249; delicacy of, 8; disappointments, 205; for normal children, 
3, 207-249; as prophylactic, 2, 211, 251, 264, 284, 308, 320, 343. 

Clothing, and acclimatization, 6; color of, 224; and indifferent 
temperature, 7; materials, 222, 223; and seasons, 205, 222-224; 
sufficiency of, 221-223, 234, 258; weight of, 222. 

Cloudbursts, 128, 135. 

Cloudiness and disease, 17, 18; estimation of, 102; in North Amer- 
ica, 102-119; physical and psychical effects of, 17-19; at sea- 
shore, 31, 104, 117, 242. 

Cold, diseases and, 6, 224-228, 279, 284, 287, 345, 350; hyperesthesia 
to, 36, 255, 257, 263; perception of, 13; waves, 57-58. 

Colds, enervation and, 227; etiology, 12, 224-228; hardening and, 
228, 230, 309; in summer, 12, 212. 

Colorado, cloudiness and humidity, 113, 114; as health resort, 160, 
246, 314, 317, 362, 363; precipitation, 130, 131, 134; tempera- 
ture, 85, 86, 89, 90, 114; Colorado Springs, Manitou, 90, 160; 
Denver, 85, 86, 113, 114, 160; Durango, 89; Glenwood Springs, 
Ouray, 161, 275; Grand Junction, Leadville, 89, 161; Pike's 
Peak, 90. 

Connecticut, cloudiness and humidity, 104; as health resort, 143- 
145, 147, 148; precipitation, 123; temperature, 66, 105; Litch- 
field Hills, 147, 148; New Haven, 66, 105, 145. 

Convalescence, 258-261, 318. 

Cuba (Havana), as health resort, 157, 280; temperature, 90. 

Cystitis, 297, 298. 

Diarrhceal diseases, 300-306; climate and, 41-43; pertussis and, 

320. 
Digestion, diseases of, 210, 258, 299-307; climate and, 41-43. 
Diphtheritic paralysis, 348. 
Dryness, see Humidity. •• 
Dust, 22, 135, 159, 161, 165, 184, 243, 275, 292, 313, 374; hot-air 

furnace and, 214; irritation from, 312, 314, 321; precipitation 

and, 19, 20. 

Ear, diseases of, 323-325. 

Earthquakes in California, 136. 

Eating, bad habits of, 38, 256, 334. 

Eczema, 350, 351; etiology, 235, 350. 

Egypt, climate, 193; as health resort, 244, 247, 274, 291, 328, 374. 

Elevations, atmosphere at, 22, 23, arterial pressure at, 293; blood 
changes at, 23-26; classification, 34; emplovment of, 40, 240, 
241, 260, 261, 268-270, 283, 295, 311, 312, 329, 330, 340, 362 
375; Metabolism at, 25, 26, 40; mountain sickness, 26, 27; 
neuroses at, 338, 345; phototherapy at, 27-29; physiology of, 
23-26; radioactivity at, 27, 28; sleep at, 338, 345; solar heat 



390 THE CLIMATIC TREATMENT OF CHILDREN 

at, 28, 29; sunburn at, 28; temperature at, 29, 30, 68, 90, 147, 

178-181. 
Emphysema, 308. 
Empyema, see Pleurisy. 
Enervation, as cause of disease, 227, 258, 344, 365; definition and 

diagnosis, 341/342; etiology, 12, 40, 212, 342, 343; prophylaxis 

and treatment, 343. 
England, cloudiness and humidity, 171-173; as health resort, 195, 

238; precipitation, 173; temperature, 171, 172; English Chan- 
nel (Isle of Wight, Jersey), 171, 195, 238, 259, 267, 304, 311, 

317, 339, 357, 358; London, 21, 172. 
Entero-colitis, see Diarrhoeal diseases. 
Enuresis, 298, 334. 
Epilepsy, 347. 
Europe, central, climate, 177-183; as health resort, 196, 239, 246, 

262, 294, 304, 306, 340. 
Europe, southern, health resorts, l()6, 197; see also Mediterranean 

Region. 
Europe, western, climate, 170-177; as health resort, 195, 196, 265, 

304, 311, 317, 359, 369, 375. 
Exercise, at elevations, 26, 27; indications for, 259, 327; indifferent 

temperature and, 7; limitations of, 7, 274, 328; overexertion, 

287, 326, 370; school life and, 38, 326. 
Exposure and disease, 224-228, 278, 279, 287. 

Florida, cloudiness and humidity, 110; frost, 78, 79, 156, 285; 
as health resort, 155-157, 244, 247, 259,265, 271, 280, 285, 290, 

312, 316, 328, 329, 358, 363; malaria, 157, 285; precipitation, 
126-129; temperature, 76-79, 109, 110; Jacksonville, St. Augus- 
tine, 76, 77, 109, 155, 156, 260; Jupiter, Palm Beach, 78, 110, 
128, 156; Key West, 78, 110, 128, 156, 280; Miami, Ormond, 
Palatka, 156; Pensacola, 155; Tampa, 78, 110, 156. 

Fog, 20, 21, 103-105, 141, 163, 164, 172, 176, 237, 265, 266, 276, 

313, 365. 

Food, as cause of disease, 39, 258, 334; forced feeding, 37. 

France, as health resort, 195, 196, 237, 248, 267, 271, 291, 306, 311, 
326, 356, 359; humidity, 175, 177; precipitation, 175, 177, 186, 
187, temperature, 174, 175, 177, 185, 187, 190; Biarritz (Bay 
of Biscay), 174., 259, 260, 267, 357; Brest (Brittany), 174; 
Corsica (Ajaccio), 190; Lyons, 175; Marseilles, Montpellier, 
185; Paris, 175; Pau, Pyrenees, 177, 248, 260, 275, 311, 328; 
see also Riviera. 

Frost, causation, 21; in summer, 82, 95, 180, 239, 241; in valleys, 
. 21, 238; in warm regions, 75, 77-79, 83, 97, 151, 155, 156, 163, 
164, 184, 190, 193, 242, 243. 

Frostbites, 235, 257, 350. 

Georgia, cloudiness and humidity, 107, 108; as health resort, 329; 
precipitation, 126-128; temperature, 75-77, 107-109; Atlanta, 
75, 107, 108, Augusta, 76, 77, 109, 155; Macon, Thomasville, 
155; Savannah, 76, 77, 109, 155. 



INDEX 391 

Germany, as health resort, 196, 238, 245, 330, 358, 359; precipi- 
tation, 173, 174, 178; temperature, 173, 174, 178, 179; Baltic 
Coast, 174, 238, 267, 306, 339; Berlin, 18, 42, 178; Black 
Forest, 178, 239; Frankfort a. M., 178; Goerbersdorf (Silesia), 
179; Harz Mts., 178, 239; Heidelberg, Munich, 178; North 
Sea Coast, 173, 238, 245, 261, 267, 311, 339, 356, 357, 359. 

Glossina, 47. 

Greece, climate and health resorts, 191, 192. 

Greenland, cloudiness and humidity, 103; as health resort, 139, 
140; precipitation, 122, 123; respiratory diseases, 44; tem- 
perature, 63. 

Gulf Coast, cloudiness and humidity, 108-112; precipitation, 126- 
129; temperature, 76-78, 82, 83, 109, 110, 112; winds, 60. 

Haemorrhagic diseases, 278-280. 

Hardening. 228-235; difficulties, 9, 229; disease caused by, 230, 

231, 309, 339; fallacies, 229; treatment by, 239-241, 265, 360, 

363, 365, 370. 
Hay-fever, etiology, 47-49; treatment, 48, 142, 322-323. 
Health resorts, classification, 167-169, 194-197; foreign, 169-197; 

North American, 139-169. 
Heart disease, 325-333; climate and, 44; congenital, 331-332; 

myocardial, 328-331; valvular, 277, 325-331. 
Heat, as diaphoretic, 9, 290; harmfulness of, 40, 212; humidity and, 

10-12; physiology of, 7-10; prickly (lichen tropicus), 212, 

222, 350. . 
Heating, 7, 211-216. 
Heat-stroke, in children, 38; etiology, 11; in Europe, 183; in 

India, 22. 
Hibernation, 255. 
Hospitals, floating, 301-303. 
Housing, 219-221; tenements and disease, 220, 264, 299; tents and 

verandas, 217. • 
Humidity, 10-13, 312, 351; fallacies, 10-11; in heated rooms, 215; 

in North America, 102-120; perception of, 11-12; at seashore, 

30, 300; perspiration and, 10; temperature and, 10-11. 
Hurricanes, 55, 57, 127. 
Hysteria, 254, 335. 

Ichthyosis, 351. 

Idaho, cloudiness and humidity, 115; precipitation, 132; tempera- 
ture, 89, 115; Snake River Valley (Boise City, Pocatello), 58, 
89, 115, 161. 

Illinois, cloudiness and humidity, 105, 106, 110, 111; precipitation, 
124, 130; temperature, 70, 71, 81, .106, 111; Cairo, 81, 111; 
Chicago, 42, 70, 71, 105, 106, 152, 153. 

India, heat-stroke in, 22; pneumonia in, 344. 

Indiana, cloudiness and humidity, 106; precipitation, 124; tem- 
perature (Indianapolis), 73, 107; French Lick, West Baden, 
153. 

Infancy, hardening in, 231; outdoor life in, 207-209, 220, 221; sum- 
mer mortality in, 41-43; see also Childhood. 



392 THE CLIMATIC TREATMENT OF CHILDREN 

Infectious diseases, climate and, 17, 18, 44-49: school life and, 
38, 253. 

Influenza, climate and, 17, 18. 

Insect-borne diseases, 45-47. 

Insomnia, 338, 344-346; climate and, 8, 241, 345, 346; nervous 
irritability and, 334. 

Intestine, tuberculosis of, 372; see also Diarrheal diseases. 

Iowa, cloudiness and humidity, 10, 110, 111; as health resort, 158; 
precipitation, 130; temperature (Des Moines), 81, 111. 

Ireland, climate and health-resorts, 171, 172. 

Islands, see Seashore. 

Italy, cloudiness and humidity, 189, 190; health resorts, 196, 197; 
malaria, 46, 187-190; pneumonia, 44; precipitation, 182, 187- 
190; temperature, 46, 181, 187-190; Florence, Pisa, 189, 246, 
248; Genoa, Leghorn, 187, 245; Lake Region (Bellagio, Pall- 
anza), 181, 247, 340; Malta, 190; Milan, Venice, 188; Naples, 
189, 220, 246; Rome, 46, 189, 204, 246; Sicily (Palermo), 190, 
244, 291, 329, 363. 

Kansas, cloudiness and humidity, 110, 111, 113, 114; precipita- 
tion, 130, 131; temperature, 81, 82, 84-87, 111, 114; Dodge 
City, 85, 114; Kansas City, Wichita, 81, 111. 

Kentucky, cloudiness and humidity, 106; precipitation, 127, 128; 
temperature, 73, 74, 107; Louisville, 73, 107. 

Kidneys, amyloidosis, 281; effect of cold and exposure on, 44, 225, 
226, 287; function of, 290; surgical affections, 295-297; tuber- 
culosis of, 377; see also Nephritis. 

Labrador, cloudiness and humidity, 103; as health resort, 139, 
140; precipitation, 122, 123; temperature, 63, 64. 

Lake Region, cloudiness and humidity, 105, 106; as health resort, 
151-153, 242, 249, 267, 276, 300, 304, 319, 351, 358, 375; pre- 
cipitation, 124, 125; temperature, 69-73, 106; winds, 60. 

Leukaemia, 272, 273. 

Louisiana, cloudiness and humidity, 108; precipitation, 127-129; 
temperature. 76, 77, 82, 83, 109, 112; New Orleans, 76, 77, 
109, 155; Shreveport, 82, 112. 

Lungs, effect of cold on, 225, 226; see also Pneumonia. 

Lymphatism, 354-362; adenoids and, 315; hereditary syphilis and, 
282. 

Madeira, climate, 178; as health resort, 279, 290, 363. 

Maine, cloudiness and humidity, 104; as health resort, 141-143, 237, 

240, 267, 302, 317; precipitation, 123-126; temperature, 66-69, 

105, 302; Belgrade, Poland Springs, Camden, Castine, 142; 

Eastport, Portland, 66, 67, 105, 142; Moosehead Lake (Kineo), 

66, 143; Mt. Desert (Bar Harbor), 66, 142, 340; Rangeley 

Lakes, 143. 
Malaria, etiology, 45-47; distribution, 45-47, 148, 149, 151, 154, 

157-159, 238, 285; treatment, 283-285. 
Malnutrition, 255-262; and neuroses, 255, 333, 334. 
Manitoba, cloudiness and humidity, 110, 111 ; precipitation, 129-131 ; 

temperature, 81-83, 111; Winnipeg, 81, 82, 111. 



INDEX 393 

Maritime Provinces, cloudiness, 104; as health resort, 140, 141, 267; 
precipitation, 123; temperature, 64, 65, 105; see also Nova 
Scotia. 

Maryland, cloudiness and humidity, 104; as health resort, 150, 151; 
precipitation, 124, 125; temperature (Baltimore) 31, 62, 67, 
105 ; Deer Park, 150. 

Massachusetts, cloudiness and humidity, 104; as health resort, 
143-145, 147, 148, 359; precipitation, 123-126; temperature, 
66-69, 105, 147; Berkshire Hills, 147, 148; Boston, 42, 66, 67, 
105, 323, 340; Cape Ann* etc., 145; Nantucket, 32, 66, 67, 105, 
144, 145. 

Mediterranean Region, climate, 183-194; as health resort, 196, 
197, 247, 259, 279, 311, 357. 

Meningitis, tuberculous, 377. 

Metabolism, in children, 2, 37; at elevations, 25, 26, 40; at puberty, 
254; and temperature, 7. 

Mexico, as health resort, 161-163, 291; precipitation, 134, 136; 
temperature, 83, 91, 92, 94, 95; Chihuahua, 92, 134; Lower 
California, 95, 136; Mazatlan, 94, 134; Mexico City, 92, 134, 
162; Saltillo, 92; Sonora (Guaymas), Topolobampo, 94. 

Michigan, cloudiness and humiditv, 105, 106; as health resort, 
151-153, 276, 302, 304; precipitation, 124, 125; temperature, 
70-72, 106, 302; Alpena, 70, 71, 106; Detroit, 42, 70, 71, 106; 
Grand Haven, Port Huron, 70-72, 106;. Mackinaw, 70, 152; 
Marquette, 70, 71, 106, 153; Mt. Clemens, 151, 276. 

Middle Atlantic Coast, cloudiness and humidity, 104; as health 
resort, 237, 238, 245, 260, 265, 280,' 311, 319, 351, 359, 
375; precipitation, 123-126; temperature, 66-69, 105; winds, 
60. 

Migraine, 349, 350. 

Milk, decomposition of, 43; supply of, 236, 299. 

Mineral springs, 143, 150-154, 458, 160, 161, 177, 195, 196; in 
cystitis, 298; in heart disease, 330; radioactivity of, 361; in 
renal lithiasis, 296; in rheumatism, 275, 276; in scrofulosis, 
360; in skin diseases, 351. 

Minnesota, cloudiness and humidity, 10, 105, 106, 110, 111; as 
health resort, 158; precipitation, 124, 125, 129-131; tempera- 
ture, 70, 71, 81, 82, 106, 111; Duluth, 70, 71, 105, 106; Moor- 
head, St. Paul, 81, 111. 

Mississippi, cloudiness and humidity, 108; precipitation, 126-129; 
temperature, 76-78, 109; Vicksburg, 76, 77, 109. 

Mississippi Valley, cloudiness and humidity, 108, 110, 111 ; as health 
resort, 158, 246; malaria, 158; precipitation, 126-131; tem- 
perature, 76-78, 81, 82, 109, 111; winds, 60. 

Missouri, cloudiness and humidity, 110, 111; precipitation, 129-131; 
temperature, 81, 82, 111, 302; Kansas City, 81, 111; St. Louis, 
81, 111, 302; Springfield, 82. 

Montana, cloudiness and humidity, 113, 114; as health resort, 159; 
precipitation, 129-131; temperature, 84-90, 114; Havre, 85, 
114; Helena, 85, 114, 130, 160; Kalispell, 89. 

Mountains, see Elevations. 

Mountain sickness, 26, 27. 



394 THE CLIMATIC TREATMENT OF CHILDREN 

Nasopharyngeal catarrh, 313-315; etiology, 215. 

Nebraska, cloudiness and humidity, 110, 111, 113, 114; as health 
resort, 159; malaria, 159; precipitation, 129-131; tempera- 
ture, 81, 82, 84-88, 111, 114; North Platte, 85, 114; Omaha, 
81, 111. 

Nephritis, 289-295; albuminuria and, 288, 289; climate and, 44; 
exposure and, 225; tuberculosis and, 371; see also Albumi- 
nuria. 

Nervous exhaustion 333, 337-342. 

Nervous irritability, 333-337, 342; habit spasms, 347; enuresis and, 
298, 334. 

Netherlands, climate, 174; health resorts, 195. 

Neuralgia, 349. 

Neurasthenia, 333, 338. 

Neuroses, 333-350; combinations of, 342; elevations and, 338, 346> 
hardening and, 231, 339; malnutrition and, 255, 333; painful, 
349, 350; thunderstorms and, 21. 

Nevada, cloudiness and humidity, 115; precipitation, 132, 133; 
temperature, 88-91, 115; Carson City, Winnemucca, 89, 115, 
161. 

New Brunswick, cloudiness, 104; as health resort, 140; precipita- 
tion, 123, 124; temperature, 64, 65, 105; Chatham, 64, 105; 
Campobello, Grand Manan, 142; St. John, 64. 

New England, cloudiness and humidity, 104 ; as health resort, 141- 
145/ 237, .262, 267, 292, 317, 329; 330, 339, 340, 361; precipita- 
tion, 123-126; temperature, 66-69, 105. . 

Newfoundland, cloudiness, 104; as health resort, 140; precipita- 
tion, 123, 124; temperature (St. John's), 64, 105. 

New Hampshire, cloudiness and humidity, 104; health resorts, 
143-145; precipitation, 123-125; temperature, 66-69; Lake 
Winnipesaukee, 143, Portsmouth, etc., 145; White Mountains 
(Bethlehem, Mt. Washington), 55-59, 142, 143, 240, 246, 272, 
323. 

New Jersey, cloudiness and humidity, 104; as health resort, 148, 
149, 237, 267, 271, 304/316, 358; malaria, 149; precipitation, 
123-125; temperature, 67, 68, 105; Asbury Park, 149; At- 
lantic City, 31, 67, 105, 149, 242, 249, 261, 339, 346, 358; Cape 
May, 149, 367; Lakewood, 61, 67, 148, 248. 

New Mexico, cloudiness and humidity, 116; as health resort, 161, 
362, 374; precipitation, 133, 134; temperature, 91, 92, 117; 
Albuquerque, 26, 161; Las Vegas, 161, 275; Santa Fe\ 91, 92, 
116, 117, 161; Silver City, 162. 

New York, cloudiness and humidity, 10, 104-106; as health resort, 
262, 316, 317, 330, 361, 375; precipitation, 123-126; temper- 
ature, 15, 66-72, 105, 106, 147; Adirondack Mts. (Saranac 
Lake), 10, 66, 145, 146, 240, 246, 276, 323, 362, 364; Albany, 
66, 67, 69, 105; Buffalo, 41, 70-72, 106, 242; Catskill Mts., 
147, 148, 272, 304, 323; Chautauqua Lake, 151, Cooperstown, 
Richfield and Sharon Springs, 66 t 150, 276; Lakes Champlain 
and George, 146; Liberty (Sullivan Co.), 66, 148, 376; Long 
Island (Southampton), 31, 66, 143-145, 237, 243, 267, 278, 300, 
304, 339, 358, 368, 369; New York City, 10, 12, 31, 41, 61, 66, 



INDEX 395 

105, 113, 137, 300, 323, 364; Oswego, 70, 105, 106; Pough- 
keepsie (Hudson Valley), 66, 147, 148; Rochester, 70, 71, 106; 
Saratoga, 148; Thousand Islands, see Ontario, Kingston. 

North America, atmospheric pressure, 52-55; cloudiness and hu- 
midity, 102-120; precipitation, 120-138; sunshine, 102-120; 
temperature, 61-102; (sensible), 103-119; topography, 50-52; 
weather, 56-60; winds, 52-60. 

North Carolina, cloudiness and humidity, 107, 108; as health resort, 
245, 271, 323, 375; precipitation, 126-129; temperature, 74-77, 
107-109; Asheville, 75, 153, 247, 260, 294; Charlotte, 75, 107, 
108, 154; Hatteras, 76, 77, 126, 260; Raleigh, Southern Pines, 
75, 107, 108, 155; Wilmington, 76, 77, 109, 129. 

North Dakota, cloudiness and humidity, 110, 111, 113; as health 
resort, 159; precipitation, 129-132; temperature, 85-88, 114; 
Bismarck, Williston, 85, 114. 

Northwest Provinces, as health resort, 159; see also Alberta, Mani- 
toba, Saskatchewan. 

Norway, climate, 170, 171 ; as health resort, 367. 

Nova Scotia, cloudiness, 104; as health resort, 140, 237, 304; pre- 
cipitation, 123; temperature (Halifax, Sydney, Yarmouth), 
64, 105 ; Sable Island, 32. 

Ohio, cloudiness and humidity, 105, 106; precipitation, 124, 125; 
temperature, 69-74, 106; Cleveland, 70, 71, 106; Cincinnati, 
Columbus, 73, 106; Toledo, 70. 

Ohio Valley, cloudiness and humidity, 106; as health resort, 153; 
precipitation, 124, 125; temperature, 73, 74, 106; winds, 60. 

Oklahoma, cloudiness and humidity, 112; as health resort, 159; 
malaria, 159; precipitation, 129-131 ; temperature, 82, 83, 112. 

Ontario, cloudiness and humidity, 105, 106; precipitation, 124, 125; 
temperature, 65, 69-72, 105, 106; Ottawa, 65, 105, 147; Parry 
Sound, Muskoka Lakes, 70, 71, 106, 152; Port Stanley, Thou- 
sand Islands (Kingston), 70, 71, 106, 151; Rockliffe, 65, 105; 
Saugeen, Toronto, 70, 71, 106; Port Arthur, White River, 70, 
71, 106, 153. 

Oregon, cloudiness and humidity, 115, 117-119; as health resort, 
165, 166, 249, 317, 340; precipitation, 132, 137, 138; tem- 
perature, 89, 90, 99, 100, 115, 119; Astoria, 99; Baker City, 
89, 115, 166; Portland, Salem, 59, 99, 100, 118, 119, 166; Rose- 
burg, 59, 99, 100, 119, 138, 166. 

Otitis and Otorrhcea, 323-325. 

Outdoor life, 7, 207-209, 220, 221, 319, 336; in winter, 221, 264. 

Pacific Coast, cloudiness and humidity, 117-119; as health resort, 
237, 249, 259, 317, 340, 358; precipitation, 135-138; tempera- 
ture, 94-102, 119; winds, 22, 58, 60; see also California. 

Palestine, climate, 193, 194. 

Paralytic affections, 347, 348. 

Pennsylvania, cloudiness and humidity, 104-106; as health resort, 
150, 323; precipitation, 124, 125; temperature, 67-74, 105-107; 
Cresson Springs, Glen Summit, Mt. Pocono, Delaware Water 



396 THE CLIMATIC TREATMENT OF CHILDREN 

Gap, 150; Erie, 70, 106; Harrisburg, 67, 105, 150; Philadel- 
phia, 67, 150, 346; Pittsburg, 73, 107; Scranton, 32, 67, 150. 

Pericarditis, 332, 333. 

Peritonitis, tuberculous, 377. 

Perspiration, see Sweat. 

Pertussis, 319-322. 

Phototherapy, at elevations, 27-29; in skin diseases, 352. 

Plains, the Great, blizzards and tornadoes, 87, 88, 131; cloudiness 
and humidity, 113, 114; dust, 22, 159; as health resort, 158, 
159, 315, 364; malaria, 159; precipitation, 129-131; tempera- 
ture, 84-87, 114; winds, 22, 60, 87. 

Plateau, the Western, cloudiness and humidity; 114, 115; precipi- 
tation, 132, 133; temperature, 88-91, 115; winds, 60; see also 
Rocky Mountains. 

Plateaus, temperature, 29, 30. 

Pleurisy, 317-319. 

Pneumatotherapy, 23; in diseases of the ear, 325. 

Pneumonia, 315-319; and climate, 44, 344; and pertussis, 320; 

and seasons, 43, 44. 
'Poliomyelitis, 348. 

Population and climate, 5. 

Portugal, climate, 175, 176; the Azores, 176. 

Precipitation, in central Europe, 178-182; in Mediterranean region, 
185-194; in North America, 120-138; at seashore, 31, 32; in 
western Europe, 171-177. 

Pressure, atmospheric, in ear diseases, 325; at elevations, 23; in 
North America, 52-55; and neuralgia, 349; and rheumatism, 
274. 

Prince Edward Island (Charlottetown), temperature, 64, 105. 

Psoriasis, heliotherapy, 352. 

Psychoses, 335. 

Puberty, 232, 254; see also Childhood. 

Pyelitis and Pyelonephritis, 295-297. 

Quebec, cloudiness, 104; precipitation, 123-125; temperature, 64, 
65, 105; Chicoutimi, 65, 146; Father Point, 64, 105; Lake St. 
John, 146; Montreal, 65, 105, 147, 323; Murray Bay, 147; 
Quebec (City), 65, 105, 147. 

Radiation, of body heat, 9; from open fire, 214; of solar heat, 7, 18, 

28, 29, 221; in solarium, 265, 266. 
Radioactivity, at elevations, 27, 28; of mineral springs, 361. 
Radiotherapy of tuberculosis, 28. 
Rain, cloud-bursts, 128, 135; disadvantages and value of, 19, 20, 

312, 373; intensity of, 138; in North America, 120-138; at 

seashore, 31, 32. 
Respiratory diseases, 210, 212, 265, 307-323; climate, seasons and, 

43, 44; see also Colds, Pneumonia, etc. 
Rest and rest cures, 4, 6-9, 35, 328, 329, 332, 337, 338. 
Rheumatism, 273-278; climate and, 44. 
Rhode Island, cloudiness and humidity, 104; precipitation, 123- 



INDEX 397 

125 ; temperature, 66, 67, 105; Block Island, 31, 60, 66, 67, 105, 

144, 145, 237; Narragansett Pier, Newport, 145. 
Rickets, 262-269; bronchitis and, 308, 310; nodding spasms and, 

347. 
Riviera, the, climate, 159, 160; as health resort, 196, 197, 245, 260, 

271, 291, 298, 311, 329, 357, 375. 
Rocky Mountains, cloudiness and humidity, 113-115; as health 

resort, 159-161, 241, 246, 260, 268, 272, 275, 283, 294, 306, 312, 

314, 325, 327, 338, 349; precipitation, 129-133; temperature, 

84-91, 114, 115; winds, 60. 

Sanatoria, 377-381; in diarrhceal diseases, 301-303, 305; in respi- 
ratory diseases, 318; in rickets, 268; in scrofulosis, 356-361; 
in tuberculosis, 367-369, 373. 

Saskatchewan, cloudiness, 113; precipitation, 129-131; tempera- 
ture, 84-87, 114; Medicine Hat, Regina, Prince Albert, 85, 114. 

School life, unfavorable influences of, 38, 253. 

Scotland, climate, 171-173; as health resort, 239. 

Scrofulosis, 354-362; and adenoid hypertrophy, 315, 355; and 
bronchitis, 308, 310; and neuroses, 333. 

Scurvy, 278. 

Sea baths, 201-204; in ear diseases, 323, 324; in malnutrition, 261; 
in paralytic affections, 348; in rickets, 266; in scrofulosis, 357, 
359; in congenital syphilis, 283. 

Seashore, cloudiness and humidity, 30, 31, 277; employment, 237, 
238, 245, 247-249, 259-261, 265-267, 277, 278, 283, 295, 300, 
301, 304, 310, 311, 320, 321, 339, 346, 348, 356-359, 367-370; 
fogs, 20, 21, 103, 104, 141, 163, 164, 172, 237; overstimulation 
at, 261, 339; precipitation, 31, 32; 'salt air, 32, 198, 321; tem- 
perature, 31, 32, 237; winds, see below. 

Sea voyages, 197-201; in tuberculosis, 370, 371. 

Skin diseases, 350-352. 

Sleep, normal amount, 344; see also Insomnia. 

Sleeping Sickness, 47. 

Snow, melting in spring, 20, 180; in Europe, 172, 176, 179, 180, 185, 
187, 188, 190, 191; in North America, 124-126, 128, 129, 131- 
134, 136, 138; usefulness, 20, 373. 

Solarium, 265, 266, 378. 

South Carolina, cloudiness and humidity, 108; as health resort* 245; 
precipitation, 126-129; temperature, ?6-78, 109; Aiken, 155; 
Charleston, 76, 77, 109, 155, 244. 

South Central States, cloudiness and humidity, 112; precipitation, 
126-129; temperature, 82-84, 112. 

South Dakota, cloudiness and humidity, 110, 111, 113, 114; pre- 
cipitation, 129-131; temperature, 81, 82, 84-87, 111, 114; 
Huron, 81, 111; Pierre, Rapid City (Black Hills), 85, 114. 

Southeastern States, cloudiness and humidity, 107-110; as health 
resort, 244, 291, 298, 311; malaria, 154, 157; precipitation, 
126-129; temperature, 74-79, 107-110; Lower South, 154-156, 
244; Pine Belt, 245, 328; Upper South, 153, 154, 244, 245, see 
also Alleghanies (Southern). 

Southwest, the, cloudiness and humidity, 116; dust storms, 135; 



398 THE CLIMATIC TREATMENT OF CHILDREN 

as health resort, 161-163, 279; precipitation, 133-135; tem- 
. perature, 91-94, 117. 

Spain, cloudiness and humidity, 184, 185; as health resort, 196, 
243; precipitation, 176, 184, 185; temperature, 175, 176, 184, 
185; Gibraltar, Malaga, 184, 291; Madrid, Valladolid, 185; 
Oviedo, 175. 

Spasmodic affections, 346, 347. 

Spinal affections, 347, 348. 

Spitzbergen, as health resort, 140. 

Spring, the advance of, 247; atmospheric pressure and winds, 53, 
54; melting of snow, 20, 180; respiratory diseases, 44; re- 
sorts, 246-248; variability of, 13, 14, 246. 

Stegomyia, 47. 

Stimulation, contraindicated, 3, 338; at elevations, 26, 40, 328, 338; 
by heat, 9, 12; by sunshine, 19, 261, 338, 339. 

Storm paths in North America, 56, 57; see also Hurricanes, Torna- 
does. 

Sultriness, 12. 

Summer, atmospheric pressure and winds, 54, 55; duration,. 109; • 
frosts, 82, 95, 180, 239, 241 ; infant mortality, 41-43; resorts, 
236-241; respiratory affections, 12, 212. 

Sunburn, 234; at elevations, 28.- 

Sunshine, absorption of, 27, 28; at elevations, 29, 181; estimation 
of, 102; in Europe, 18, 104-106, 171, 181, 185, 189; exposure 
to, 7, 15, 18, 219-221; germicidal effects of, 18, 219; indifferent 
temperature in,' 7, 8; in North America, 102-120; stimulating 
effects of, 19, 261, 338, 339. 

Sunstroke, see Heat-stroke. 

Sweat, causation and function, 9, 10. 

Sweden, climate, 170, 171.. 

Switzerland, cloudiness and humidity, 180-182; health resorts, 196; 
precipitation, 180-182; temperature, 179-181; Davos, 180, 
181; Engadine (Arosa, St. Moritz), 29, 180, 204, 270, 273, 328; 
Lake of Geneva (Montreux), 181, 280, 340, 361; Lake of Lu- 
cerne (Altdorf), 179; Lugano, 181; Zurich, 179, 181, 361; see 
also Alps. 

Syphilis, congenital, 282, 283; bronchitis and, 309. 

Syria, climate, 193, 194. 

Teeth, defects of, 255, 256, 349. 

Temperature in cities, 62, 300; at elevations, 29, 30, 68, 90, 147, 
178-181; humidity and, 10-12; inversion of, 29, 68, 91, 180; 
metabolism and, 7; in North America, 61-102; of ocean, 202, 
203; for outdoor life, 7, 208, 221; perception of, 13-17; for 
rest cures, 8; in rooms, 7, 211, 212, 265; in rural districts, 62, 
300; at seashore, 31, 32; sleep and, 8, 345; for training 
cures, 8. 

Temperature, indifferent, 7; in water, 8, 16, 360; in childhood, 
39, 205, 212. 

Temperature, sensible, 14-17; in North America, 102-120. 

Temperature, variability of, 13, 14; in Europe, 183; in North Amer- 
ica, 52, 58, 68, 71, 74, 75, 77, 82, 83, 87, 90, 92, 99, 183. 



INDEX 399 

Tennessee, cloudiness and humidity, 107; precipitation, 127, 128; 
temperature, 74-76, 107, 108; Knoxville, 75, 107, 154; Look- 
out Mountain, 154; Memphis, Nashville, 75, 107, 108. 

Texas, cloudiness and humidity, 112-114, 116; malaria, 159; pre- 
cipitation, 126-129, 133-135; temperature, 82-87, 91, 92, 112, 
114, 117; Abilene, Amarillo, 85, 114; Corpus Christi, San An- 
tonio, 82, 112; El Paso, 91, 92, 117, 133, 134, 162; Galveston, 
82, 112, 155. 

Thunderstorms, and neuroses, 21; in North America, 123, 124, 129, 
131, 133-136, 138. 

Tornadoes, 22, 87, 129, 131. 

Training, delicacy of, 8; difficulties, 4, 6, 210; indications, 3, 35, 
40; temperature and, 8; see also Hardening. 

Tropics, harmfulness of, 13, 40; origin of man in, 6; pneumonia in, 
44, 344. 

Tuberculosis, 355-381; adenoids and, 355; advanced, 375, 376; age 
and, 353, 366, 372; amvloidosis and, 281, 371; climate and, 
362-365; forms of, 353, 369, 370; hardening and, 370, 377; in- 
cipient, 372; intestinal, 372; laryngeal, 375; latent, 259; men- 
ingeal, 377; miliary, 366, 372; peritoneal, 377; pleural, 377; 
polymorphism of, 353, 366; pulmonary, 372-377; radiotherapy 
of, 28; renal, 377; sanatoria, 367-369, 376-381; sea voyages 
in, 370, 371; surgical, 366-371; travel and, 376; visceral, 
371-377; see also Scrofulosis. 

United States, pneumonia in, 44; see also North America. 
Utah, cloudiness and humidity, 115; precipitation, 132, 133; tem- 
perature, 88-90, 115; Salt Lake City, 89, 115, 161, 360. 

Valleys, fogs in, 21, 105; frost in, 21, 238; inversion of temperature 

in, 29; undesirability of, 238. 
Vasomotor system, heat and, 12; training of, 228. 
Vegetation in North America, 63, 65, 69, 72, 74-76, 78, 83, 84, 91. 

100, 115, 155, 
Ventilation, 211-219; house-airing, 218. 
Vermont, cloudiness and humidity, 104; as health resort, 143, 323; 

precipitation, 123-126; temperature, 66-69, 105; Northfield, 

66, 67, 105. 
Virginia, cloudiness and humidity, 104; as health resort, 150, 151, 

243, 323, 328, 359; precipitation, 124-126; temperature, 66-69, 

105; Hot Springs, 150, 276, 294; Lynchburg, 67, 105; Norfolk, 

Old Point Comfort, 67, 105, 150, 248, 339; Richmond, 67; 

WytheviUe, 67, 150. 

Washington, D. C, 62, 67, 105, 323. 

Washington (State), cloudiness and humidity, 115, 117-119; as 
health resort, 165, 166, 249, 340; precipitation, 132, 133, 137, 
138; temperature, 88-90, 99-101, 115, 119; Puget Sound 
(Seattle, Olympia), 99, 118, 119, 166, 317; Spokane, Walla 
Walla, 89, 115, 166; Tatoosh Island, 99, 100, 118, 119. 

Weather and climate, 4; in Central Europe, 183; in North America, 
56-60, 183, and neuralgia, 349; and rheumatism, 274. 



400 THE CLIMATIC TREATMENT OF CHILDREN 

Weight of children, 256. 

West Indies, as health resort, 13, 280, 363. 

West Virginia, cloudiness and humidity, 106; as health resort, 150; 
precipitation, 124-126; temperature (Parkersburg), 73, 74, 
107. 

Windows, management of, 216-219. 

Winds, cold (bora, mistral, norther), 21, 59, 78, 83, 185, 186, 190, 
. 221, 314; Chinook, foehn, 57, 59, 84, 86, 175, 179; hot (sir- 
occo), 22, 87, 95, 183, 184, 190, 191*; monsoon, 79; in North 
America, 52-60; physiology of, 21-23; sea breeze, 22, 31, 60, 
96, 97, 143, 184, 208, 221, 237, 247, 248; shelter from, 8, 58, 
221, 373; storms, 21, 56, 57, see also Tornadoes; trade, 53-55; 
velocity of, 60. 

Winter, atmospheric pressure and winds, 52, 53; hardening in, 260; 
rain and snow, 19, 20; resorts, 241-246; sunshine, 17, 18. 

Wisconsin, cloudiness and humidity, 105, 106, 110, 111; precipita- 
tion, 124, 125, 129-131; temperature, 69-72, 81, 82, 106, 111; 
Green Bay, 70, 71, 106; La Crosse, 81, 111; Milwaukee, 70-72, 
106; Waukesha, 152. 

Wyoming, cloudiness and humidity, 113, 114; as health resort, 160; 
precipitation, 129-131; temperature, 84-87, 114; Cheyenne, 
Lander, 85, 114; Yellowstone Park, 85, 160. 

Yellow Fever, 47. 

Yukon (Dawson City), 101, 102. 



MAY 15 1907 



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